Next Frontiers in Systemic Therapy for Soft Tissue Sarcoma

Cheuh-Chuan Yen; Tom Wei-Wu Chen

Disclosures

Chin Clin Oncol. 2018;7(4) 

In This Article

Summary

Two trends are pushing the frontiers in the treatment of oncology patients: molecular target agents that more closely matched to the genomic alterations or biological mechanisms of the cancer and reactivation or modulation of the immune system to fight cancer. STS treatments have not lagged too much behind in both of these two categories. In molecular targeted agents, many anti-angiogenic factors have shown activity in STS and PDGFRA monoclonal antibody in combination with doxorubicin have also improved the survival of advanced STS patients. Other STS-specific genomic or molecular target inhibitors such as CSF-1R, SINE, MDM2, CDK4, and EZH2 are also showing promising future. How to match the current wave of precision oncology with sound and solid clinical trial evidence is also a key to finding the optimal treatments of each STS patient.

In immunotherapy treatments, single agent ICI may have activity in certain histologies but definitely is not the answer for most advanced STS patients. Combinations of either two ICI inhibitors or other molecular targeted agents that can modulate the tumor microenvironment is under intense investigation. Other immunotherapy methods such as viral vaccines or adoptive T cells are front-runners that target the CTA NY-ESO-1. Immune system is like the yin and yang, always in process of balancing the enhancing and suppressive factors of the immune system. A deeper understanding of the immune contexture to understand the resistance in immunotherapy plays another key role to extending the envelope of the frontier in the treatment of advanced STS.

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