New developments in soft tissue and bone sarcoma research

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Published: 21 Mar 2019
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Prof Hans Gelderblom - Universiteit Leiden, Leiden, Netherlands

Prof Hans Gelderblom speaks to ecancer at the 2019 EORTC Groups Annual Meeting (EGAM) about the discussions that took place in the EORTC's Soft Tissue and Bone Sarcoma group.

Prof Gelderblom explains the designs of three trials that are have taken place in the group. These include the ALT-GIST trial which examined the effect of imatinib and regorafenib on progression-free survival for gastrointestinal stromal tumours (GIST).

Furthermore, he also mentioned the phase-II CABOGIST trial which aimed to evaluate the safety and activity of cabozantinib in patients with metastatic GIST and the STRASS study that administered pre-operative radiotherapy to retroperitoneal soft tissue sarcoma patients.

Prof Gelderblom also revealed details of a new trial that is under development and will focus on the use of combination chemotherapy for leiomyosarcoma.

Due to the diversity of sarcoma subtypes, Prof Gelderblom believes trials should be conducted with collaborators across Europe, in order to investigate these more rare subtypes.

Today we discussed, as we always start, with the subgroups, so pathology, systemic treatment, local treatment, imaging, quality of life. Then we get together as a whole group, about eighty people were attending this year which is a good number, and then we discuss the trials that are pre-ASCO, we call that. So that’s really talking about new trials and that’s important to keep the group growing, to advance science in sarcoma. Then we did the trials that are in development and then finally the trials that are running right now.

Can you mention some of the significant updates from trials this year?

Yes, there were three trials that will be presented at ASCO, which is quite a good number. Of course I cannot tell the results here but I can tell the designs of the trials. The first one is the ALT-GIST trial, it’s a trial in metastatic gastrointestinal stromal tumours, GIST, where we alternate the standard regimen of imatinib with regorafenib in the hope to prolong the progression free survival. This was an intergroup trial and will be presented at ASCO.

The second trial is the so-called CABOGIST trial. That’s a phase II trial in patients with metastatic GIST after two lines of prior therapy where cabozantinib, a well-known drug in oncology, is given to the patients and we have high hopes for the results there.

The third trial is a very important trial, it’s the STRASS trial. It’s a trial where we give in a randomised way pre-op radiotherapy to retroperitoneal soft tissue sarcoma. It’s a truly academic trial; it’s an important trial that we did together with US centres. This trial leads in to the STRASS-2 trial that we are currently in full development and this is a study where pre-op chemotherapy will be given to these patients also in a randomised way.

Was there anything that stood out to you from the EGAM meeting this year?

What we always do is we mine our database. So we have an extremely large database on prospective data of soft tissue sarcoma patients and many projects come from there. One of the projects was about angiosarcoma and another one was on leiomyosarcoma with different drugs. This is a very important asset of the EORTC and the SWOG that we have so many patients where we can learn from and use as a basis for novel and new trials. So one of the new trials we will develop is the combination chemotherapy in leiomyosarcoma, so this is coming out of this retrospective work.

What goals has the soft tissue group set to achieve over the next few years?

The goals we really define are several things. Sarcoma is a bunch of seventy, seven-oh, different subtypes and the EORTC is in a unique position to do trials in such ultra-rare indications. This needs to be looked at in a pan-European way so we really want to embark on studies in ultra-rare subtypes with a good molecular alteration where a certain drug fits to. That’s one of the things we are really pursuing. Another thing is that we will continue to do academic trials, so really trials where the pharmaceutical industry has no benefit because these drugs are off-patent. We want to keep doing that and look for alternative financing resources. So that’s important twofold – rare indications on a European level and academic studies, prospective, and, of course, the database which is very important.