Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial - 01/04/14
, Jaap Verweij, ProfPhD b, Hans Gelderblom, ProfPhD c, Jörg T Hartmann, ProfMD d, e, f, Patrick Schöffski, ProfMPH g, Jean-Yves Blay, ProfPhD h, i, J Martijn Kerst, PhD j, Josef Sufliarsky, ProfMD k, Jeremy Whelan, ProfMD l, Peter Hohenberger, ProfMD m, Anders Krarup-Hansen, MD n, Thierry Alcindor, ProfMD o, p, Sandrine Marreaud, MD q, Saskia Litière, PhD q, Catherine Hermans q, Cyril Fisher, ProfDSc a, Pancras C W Hogendoorn, ProfPhD c, A Paolo dei Tos, ProfMD r, Winette T A van der Graaf, ProfPhD sfor the European Organisation and Treatment of Cancer Soft Tissue and Bone Sarcoma Group†
Summary |
Background |
Effective targeted treatment is unavailable for most sarcomas and doxorubicin and ifosfamide—which have been used to treat soft-tissue sarcoma for more than 30 years—still have an important role. Whether doxorubicin alone or the combination of doxorubicin and ifosfamide should be used routinely is still controversial. We assessed whether dose intensification of doxorubicin with ifosfamide improves survival of patients with advanced soft-tissue sarcoma compared with doxorubicin alone.
Methods |
We did this phase 3 randomised controlled trial (EORTC 62012) at 38 hospitals in ten countries. We included patients with locally advanced, unresectable, or metastatic high-grade soft-tissue sarcoma, age 18–60 years with a WHO performance status of 0 or 1. They were randomly assigned (1:1) by the minimisation method to either doxorubicin (75 mg/m2 by intravenous bolus on day 1 or 72 h continuous intravenous infusion) or intensified doxorubicin (75 mg/m2; 25 mg/m2 per day, days 1–3) plus ifosfamide (10 g/m2 over 4 days with mesna and pegfilgrastim) as first-line treatment. Randomisation was stratified by centre, performance status (0 vs 1), age (<50 vs ≥50 years), presence of liver metastases, and histopathological grade (2 vs 3). Patients were treated every 3 weeks till progression or unacceptable toxic effects for up to six cycles. The primary endpoint was overall survival in the intention-to-treat population. The trial is registered with ClinicalTrials.gov, number NCT00061984.
Findings |
Between April 30, 2003, and May 25, 2010, 228 patients were randomly assigned to receive doxorubicin and 227 to receive doxorubicin and ifosfamide. Median follow-up was 56 months (IQR 31–77) in the doxorubicin only group and 59 months (36–72) in the combination group. There was no significant difference in overall survival between groups (median overall survival 12·8 months [95·5% CI 10·5–14·3] in the doxorubicin group vs 14·3 months [12·5–16·5] in the doxorubicin and ifosfamide group; hazard ratio [HR] 0·83 [95·5% CI 0·67–1·03]; stratified log-rank test p=0·076). Median progression-free survival was significantly higher for the doxorubicin and ifosfamide group (7·4 months [95% CI 6·6–8·3]) than for the doxorubicin group (4·6 months [2·9–5·6]; HR 0·74 [95% CI 0·60–0·90], stratified log-rank test p=0·003). More patients in the doxorubicin and ifosfamide group than in the doxorubicin group had an overall response (60 [26%] of 227 patients vs 31 [14%] of 228; p<0·0006). The most common grade 3 and 4 toxic effects—which were all more common with doxorubicin and ifosfamide than with doxorubicin alone—were leucopenia (97 [43%] of 224 patients vs 40 [18%] of 223 patients), neutropenia (93 [42%] vs 83 [37%]), febrile neutropenia (103 (46%) vs 30 [13%]), anaemia (78 [35%] vs 10 [5%]), and thrombocytopenia (75 [33%]) vs one [<1%]).
Interpretation |
Our results do not support the use of intensified doxorubicin and ifosfamide for palliation of advanced soft-tissue sarcoma unless the specific goal is tumour shrinkage. These findings should help individualise the care of patients with this disease.
Funding |
Cancer Research UK, EORTC Charitable Trust, UK NHS, Canadian Cancer Society Research Institute, Amgen.
Le texte complet de cet article est disponible en PDF.Plan
Vol 15 - N° 4
P. 415-423 - avril 2014 Retour au numéro
Article précédent
- Clinical validity of circulating tumour cells in patients with metastatic breast cancer: a pooled analysis of individual patient data
- François-Clément Bidard, Dieter J Peeters, Tanja Fehm, Franco Nolé, Rafael Gisbert-Criado, Dimitrios Mavroudis, Salvatore Grisanti, Daniele Generali, Jose A Garcia-Saenz, Justin Stebbing, Carlos Caldas, Paola Gazzaniga, Luis Manso, Rita Zamarchi, Angela Fernandez de Lascoiti, Leticia De Mattos-Arruda, Michail Ignatiadis, Ronald Lebofsky, Steven J van Laere, Franziska Meier-Stiegen, Maria-Teresa Sandri, Jose Vidal-Martinez, Eleni Politaki, Francesca Consoli, Alberto Bottini, Eduardo Diaz-Rubio, Jonathan Krell, Sarah-Jane Dawson, Cristina Raimondi, Annemie Rutten, Wolfgang Janni, Elisabetta Munzone, Vicente Carañana, Sofia Agelaki, Camillo Almici, Luc Dirix, Erich-Franz Solomayer, Laura Zorzino, Helene Johannes, Jorge S Reis-Filho, Klaus Pantel, Jean-Yves Pierga, Stefan Michiels
- Rituximab versus a watch-and-wait approach in patients with advanced-stage, asymptomatic, non-bulky follicular lymphoma: an open-label randomised phase 3 trial
- Kirit M Ardeshna, Wendi Qian, Paul Smith, Nivette Braganca, Lisa Lowry, Pip Patrick, June Warden, Lindsey Stevens, Christopher F E Pocock, Fiona Miall, David Cunningham, John Davies, Andrew Jack, Richard Stephens, Jan Walewski, Burhan Ferhanoglu, Ken Bradstock, David C Linch
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?