Ifosfamide - etoposide chemotherapy in patients with advanced adult soft tissue sarcomas

9062 Background: Doxorubicin and ifosfamide are considered to be the two most active agents in the treatment of adult soft tissue sarcoma (STS). Etoposide has substantial activity in wide range of malignancies and is highly active against sarcomas in children and young adults when combined with ifosfamide. There are several conflicting data about the effect of ifosfamide - etoposide combination chemotherapy in adult patients with STS. The objective of current study was to determine the efficacy of this combination in advanced adult STS. Methods: Patients who had histologically confirmed advanced non-small round cell STS were enrolled. At least 4 weeks interval was present since previous chemotherapy. Patients received 5-day cycles of ifosfamide (1.8g/m2/day) and etoposide (100mg/m2/day). Etoposide was administered over 2 hours and followed immediately by ifosfamide infused over 2 hours. Mesna uroprotection (60% dose of ifosfamide) was given. The response was evaluated after at least two chemotherapy courses. Results: Twenty-two patients (15–69 years, median 41) with advanced adult STS were enrolled onto this study. Histological diagnoses comprised 6 synovial sarcoma, 5 MFH, 5 MPNST, 2 liposarcoma, 2 leiomyosarcoma, and 2 others. Primary sites were extremity in 14 and trunk in 8. Evaluation sites were metastatic disease in 13, local recurrence in 5 and inoperable primary tumor in 4. Six patients achieved partial response, 14 had stable disease and 2 had progressive disease, with an overall response rate of 27%. Of 8 patients who had received previous anthracycline containing chemotherapy, two responded. Two of five patients with MPNST and MFH had objective tumor regression. Treatment was well tolerated except for neutropenic fever that occurred in 10% of the courses. Conclusions: Etoposide has minimal activity in advanced adult STS when combined with ifosfamide using this administration regimen. Considering the schedule dependency of etoposide, the contribution of prolonged infusion of etoposide combining with ifosfamide should be further investigated. No significant financial relationships to disclose.