Treatment of advanced soft tissue sarcoma: efficacy and safety of trabectedin, a multitarget agent, and update on other systemic therapeutic options

Soft tissue sarcomas (STS) are rare mesenchymal cancers. Despite optimal management, nearly 50% of patients with localized disease will develop recurrence. The outcome for patients with metastatic STS is poor. There are few systemic treatment options available in this setting. Doxorubicin, with or without ifosfamide, is considered standard first line therapy. We herein review the evidence for the use of trabectedin in adult advanced soft tissue sarcoma. Some clinical trials have confirmed the activity of trabectedin as an effective and tolerable option for adult patients previously treated with doxorubicin and ifosfamide. Trabectedin was approved in the European Union and other countries based on the results of a randomized phase II trial involving patients with advanced liposarcoma and leiomyosarcoma receiving one of two different schedules of trabectedin. Recently a multicentre phase III trial randomized liposarcoma and leiomyosarcoma patients to receive either trabectedin or dacarbazine, demonstrating a significantly improved progression-free survival for patients treated with trabectedin compared to dacarbazine.