The efficacy and safety of anlotinib combined with chemotherapy in treatment of advanced soft tissue sarcoma

Our plain-English summary of The efficacy and safety of anlotinib combined with chemotherapy in treatment of advanced soft tissue sarcoma, by Y. Ni, Y. Dong, A. Jiang, et al (Discover Oncology, 2024).

The study

• Authors: Y. Ni, Y. Dong, A. Jiang, Q. Zhang, Z. Wang, H. Liang, W. Zhang
• Journal: Discover Oncology
• Published: 2024;15(1):598
• Cited by: 4 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Background: To evaluate the efficacy and safety of anlotinib combined with chemotherapy in the treatment of advanced soft tissue sarcoma (STS).

Methods: A total of 14 patients with advanced STS consisting of 4 liposarcoma, 3 undifferentiated polymorphous sarcoma, 2 synovial sarcoma, 1 Extraosseous ewing sarcoma, 1 spindle cell sarcoma, 1 Sarcomatoid malignant mesothelioma, 1 hemangiosarcoma, and 1 fibrosarcoma, were treated with anlotinib plus chemotherapy. The anlotinib was combined with chemotherapy as the first-line treatment in 13 patients, and as second-line treatment in 1 patient. Chemotherapy regimens were based on anthracyclines and ifosfamide, and other drugs included paclitaxel, and so on. Efficacy and safety were evaluated every 2 treatment cycles.

Results: According to the stage of AJCC, 9 patients were stage III and 5 patients were stage IV. The average cycle of treatment is 3.86. Among the 14 patients, 2 cases had received surgical treatment after neoadjuvant chemothrapy, 5 cases had partial response (PR), 7 cases had stable disease (SD), and 2 cases had progressive disease (PD). The overall response rate (ORR) was 35.7% (5/14). Patients who had not underwent surgical treatment were with a disease control rate (DCR) of 83.3% (10/12). The median progression free survival (PFS) was 8.25 months. The common treatment-related adverse effects included bone marrow suppression, nausea, vomiting and hypertension. Three patients had severe adverse effect, which was febrile neutropenia. No treatment-related death was found.

Conclusions: Anlotinib combined with chemotherapy in the treatment of STS is effective and tolerable, which is a promising strategy. It is worthy of further clinical research.

© 2024. The Author(s).

In plain English

This retrospective study covered 14 patients with advanced soft tissue sarcoma at a Shanghai cancer center, July 2019 to March 2020. Patients took oral anlotinib (12 mg daily for 14 days, then 7 days off, in 21-day cycles) with chemotherapy based mainly on anthracyclines and ifosfamide. One patient had sarcomatoid malignant mesothelioma. Asbestos is not mentioned. Of the 14, 5 had a partial response, 7 stable disease and 2 progressive disease, an overall response rate of 35.7% (5/14). Two patients had surgery after the combination treatment; among the other 12, disease control rate was 83.3% (10/12). Median progression-free survival was 8.25 months (95% CI 4.88 to 11.62); the accompanying figure covers patients not operated on after treatment. Grade 3 to 4 neutropenia occurred in 5 patients (35.7%), and no one stopped treatment over side effects. The mesothelioma shrank from 12.4 cm to 7.5 cm after two cycles, measured 8.1 cm before surgery, and was fully removed (R0). The authors concluded that the combination improved response and progression-free survival compared with previous results. They noted the small sample and retrospective design.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: retrospective case series (single treatment group, no comparison group)
• Who was studied: 14 patients with advanced soft tissue sarcoma (9 male, 5 female; 9 stage III, 5 stage IV), Fudan University Shanghai Cancer Center Minhang Branch, Shanghai, China, July 2019 to March 2020. Tumor types: 4 liposarcoma, 3 undifferentiated polymorphous sarcoma, 2 synovial sarcoma and 1 each of extraosseous Ewing sarcoma, spindle cell sarcoma, sarcomatoid malignant mesothelioma, hemangiosarcoma and fibrosarcoma. Twelve had previously had surgery and four had previously had chemotherapy.
• Exposure: Drug treatment, not asbestos: oral anlotinib 12 mg once a day for 14 days, then 7 days off (21-day cycle), combined with chemotherapy based on anthracyclines and ifosfamide, with other drugs including paclitaxel. No asbestos or fiber exposure is described.
• Main results:
  • Of the 14 patients, 5 had partial response, 7 had stable disease and 2 had progressive disease
  • Overall response rate in all 14 patients was 35.7% (5/14)
  • Two stage III patients had surgery after the combination treatment (given as neoadjuvant chemotherapy); among the 12 patients who did not go on to surgery after treatment, the disease control rate was 83.3% (10/12)
  • Median progression-free survival was 8.25 months (95% CI 4.88 to 11.62); the accompanying Fig. 2 is labelled as showing progression-free survival of patients who did not undergo surgery after the combination treatment
  • Grade 3 to 4 neutropenia occurred in 5 of 14 patients (35.7%); no patient discontinued treatment because of adverse events
  • The sarcomatoid malignant mesothelioma patient's tumor measured 12.4 cm at diagnosis, 7.5 cm after 2 cycles and 8.1 cm before surgery (still rated partial response), followed by R0 surgical resection; this patient had grade 4 febrile neutropenia after the third cycle
• The authors' conclusion: The authors concluded that chemotherapy plus anlotinib improved overall response rate and progression-free survival compared with previous results, with controllable adverse events
• Limitations the authors state:
  • Small total sample size
  • Retrospective design, with possible selection bias, recall bias, confounding and incomplete data

Topics

Medical terms in this study, explained in our Lexicon: Chemotherapy, Sarcoma, Synovial Sarcoma, Spindle Cell, Sarcomatoid, Mesothelioma, AJCC, Neutropenia.

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