The place of trabectedin in the treatment of soft tissue sarcoma: an umbrella review of the level one evidence

Introduction: There has been significant progress in the development of new anti-soft tissue sarcoma (STS) medications with an orphan drug status in the last two decades. The histological diversity of STS (more than 50 histotypes) makes it challenging to ascertain the treatment choice in a patient-centered manner. Authors aim to reveal especially the place of trabectedin in the treatment of STS in the context of the existing competitive treatments.Areas covered: An umbrella review was performed of level one of evidence, as defined for Supportive and Palliative Care Studies for orphan drugs. Systematic reviews, meta-analyses and phase 3 clinical trials published until January 2019 were retrieved from Medline, Scopus, Cochrane databases, and Google Scholar.Expert opinion: Trabectedin is indicated for cases with relapse or as a second-line treatment, either as a monotherapy or in combination with other anti-cancer drugs. Although not universally useful, trabectedin does not have a significant adverse effect on quality of life, presents a favorable toxicological profile and boasts achievement of disease control and improvements in progression-free survival. Further studies are urgently needed to evaluate the efficacy and safety of trabectedin as compared with the emerging competitive drugs.