State of the art in soft tissue sarcomas

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Published: 21 Dec 2016
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Dr Axel Le Cesne - Gustave Roussy Institute of Oncology, France

Dr Le Cesne speaks with ecancertv at the IX French-Brazilian Oncology Congress about developments in treatment guidance for patients with soft tissue sarcomas.

Considering developments in multi-disciplinary treatments, including pre-surgical induction chemotherapy or radiotherapy, and greater understanding of genetic alterations in advanced disease, he describes the global potential in treating sarcoma patients.

He highlights communication and collaboration as an essential step to making the best of patient samples, for clinicians and other patients around the world.

I gave during these three different sessions what is the state of the art in the different diseases. It’s complicated to make a centrepiece for the three different topics but the key messages of the three talks are that it is important to know when you take charge of a patient with localised disease it’s important to have a diagnosis before surgery. If we want to make progress in this field of disease it is important to make a biopsy, initial biopsy, to have the correct diagnosis before any local regional treatment of the disease because we can totally cure a patient with a localised sarcoma and sometimes we make a lot of mistakes if we operate the patient without any biopsy, so important things. Multidisciplinary discussion with different specialists of sarcoma – I mean surgeon, radiologist, medical oncologist, pathologist, radiotherapist – when you have localised disease you make a biopsy and then we define the strategy to try to cure the patient, especially in this new era where we can propose to the patient treatment before surgery. There is a new paper, a new advance in this field where we can discuss the role of induction chemotherapy before surgery in order to facilitate surgery. It is very, very important to make the correct surgery with a so-called [?? 2:18], means to totally resect a soft tissue sarcoma and to achieve this fact we can propose induction chemotherapy or induction radiation therapy before surgery. So the first important message – initial biopsy; the second point – multidisciplinary discussion to increase the rate of curable disease.

The other key points are made in the advanced disease where in the field of mesenchymal tumour we made a lot of progress in the biology of sarcoma. We try to define new pathways, new gene alterations, new targets in each histological subtype and we have a chance to have a lot of company today with a lot of different drugs which could act against these pathways. So the future of sarcoma in the advanced situation is try to make a new classification based on this abnormality at the gene level or protein level to try to discover more targets with these new agents. We have made a lot of progress in the field of mesenchymal tumours; we have at least six or seven histologic subtypes totally defined at the biological level and we have the chance to have active agents against targets. There is a lot of improvement in some niche, in some histological subtypes and the future is to try to have exactly the same approach in all histological subtypes.

The important last message in the field of sarcoma is to try to work together. It’s impossible to take charge of sarcoma alone, to keep the information alone. It’s impossible to work like that. It’s important, especially in Brazil, to try to implement the Brazilian Sarcoma Group, for example, who identified referral centres, discussion between all the teams taking in charge this patient, to make progress. It’s mandatory to collect fresh tissue, frozen tissue in referral centres to have exactly a registry of what’s happening in Brazil. The incidence of sarcoma is exactly the same in the world so it means there are maybe 15,000-16,000 new cases of sarcoma per year in Brazil so it’s not such a rare situation. But there is a clear correlation between the correct initial taking charge and the behaviour of the patient. If you’ve taken charge correctly of the patient you can cure the patient; if you don’t take charge correctly at the beginning of the story you can kill the patient. So it’s very important to know what is a sarcoma and the role of the multidisciplinary approach at the beginning of the story not at the end of the life.