CancerNetwork® spoke with Sylvie Bonvalot, MD, PhD, at the ASCO 2021 Annual Meeting to discuss treatment options for high grade or grade II sarcoma.
At the 2021 American Society of Clinical Oncology (ASCO) annual meeting, CancerNetwork® spoke with Sylvie Bonvalot, MD, PhD, from Institut Curie, about standards of care and treatment options for patients with high grade or grade II sarcoma.
Bonvalot discusses a Phase 2/3 trial (NCT02379845) that used the NBTXR3 radio amplifier as a preoperative treatment with radiation therapy for high-grade sarcoma. The results of this study were positive and supported the use of NBTXR3 in patients with locally advanced soft tissue sarcoma.
In locally advanced sarcoma of at least high grade or grade 2 [disease], the standard treatment is surgery and radiotherapy and more and more [is by] local treatment. Radiation therapy is delivered preoperatively because long-term morbidity is lower than postoperative therapy. There was a trial conducted by O’Sullivan a few years ago and preoperative radiation therapy clearly gave better long term results; [however] you can’t do this for everyone.2
When there was an indication and sufficient adjustment for appropriate radiotherapy, we do more postoperative radiotherapy. This is for high grade locally advanced sarcoma. Regarding chemotherapy, this is not the standard of care. They would debate, it depends on the subtype, but neoadjuvant chemotherapy is always an option in the recommendations; it is not always the patient. Usually for locally advanced grade II or III sarcomas, the standard of care is radiation therapy and surgery and the option is chemotherapy for a subset of patients with a specific subtype, [such as a] young patient because conventionally it is a bit difficult for elderly patients. It is not the standard of care for administering chemotherapy for outpatient surgeries and why the standard is radiation therapy and surgery. In this essay that we did, we discuss [patients] within the multidisciplinary tumor committee. In the case of locally advanced high-grade sarcoma, the conclusion was radiation therapy and surgery, and the patient was offered the trial.
1. Bonvalot S, Rutkowski P, Thariat J, et al. Long-term evaluation of the new NBTXR3 radio amplifier plus radiotherapy in patients with locally advanced soft tissue sarcoma treated in the Phase II / II Act.In.Sarc trial. . J Clin Oncol. 2021; 39 (suppl 15): 11544. 10.1200 / JCO.2021.39.15_suppl.11544
2. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in limb soft tissue sarcoma: a randomized trial. Lancet. 2002; 359 (9325): 2235-2241. doi: 10.1016 / S0140-6736 (02) 09292-9