What is the clinical evidence from this study?

Study design: Cohort. Population: Retroperitoneal dedifferentiated liposarcoma (n=84). Intervention: Combination chemotherapy vs. Single-agent chemotherapy. Primary outcome: Objective response rate (ORR) to first-line chemotherapy (p=0.0019).

September 13, 2017Open Access

Role of chemotherapy in dedifferentiated liposarcoma of the retroperitoneum: defining the benefit and challenges of the standard

Key Result

Combination chemotherapy yielded a significantly higher objective response rate compared to single-agent therapy (24% vs 0%) in patients with retroperitoneal dedifferentiated liposarcoma.

Study Design

Type

Cohort (n=84)

Multicenter

Structured PICO

Does chemotherapy improve response rates and survival in patients with retroperitoneal dedifferentiated liposarcoma?

Population

84 adults with retroperitoneal well-differentiated/de-differentiated (WD/DD) liposarcoma who received first or second line chemotherapy and had imaging available for response assessment, mean age 55.3, 58.3% male.

Intervention

First-line chemotherapy (combination chemotherapy in 88%, single agent in 12%; 80% received an anthracycline-containing regimen, most commonly doxorubicin and ifosfamide).

Outcome

Response rate assessed by RECIST 1.1 and qualitative vascular response.surrogate

Combination chemotherapy provides a higher response rate and clinical benefit in retroperitoneal dedifferentiated liposarcoma than previously reported, and vascular response assessment may capture benefits missed by standard RECIST criteria.

Main Result

Absolute Event Rate: 24% vs 0%

p-value: p=0.0019

Limitations

Retrospective design
Heterogeneity in the treatments received
Limited number of patients
Potential selection bias as sicker patients may not have been offered combination chemotherapy

Abstract

Benefit from chemotherapy for well-differentiated/de-differentiated (WD/DD) liposarcomas has been reported to be minimal, however traditional response criteria may not adequately capture positive treatment effect. In this study, we evaluate benefit from first-line chemotherapy and characterize imaging response characteristics in patients with retroperitoneal (RP) WD/DD liposarcoma treated at The University of Texas MD Anderson Cancer Center. Response was assessed using RECIST (Response Evaluation Criteria in Solid Tumors) and an exploratory analysis of vascular response was characterized. Among 82 patients evaluable for response to first-line therapy, 31 patients received neoadjuvant chemotherapy for localized/locally advanced disease; 51 received chemotherapy for unresectable recurrent/metastatic disease. Median overall survival from the start of chemotherapy was 29 months (95% CI 24-40 months). Response rates by RECIST: partial response (PR) 21% (17/82), stable disease (SD) 40%, and progression (PD) 39%. All RECIST responses were in patients receiving combination chemotherapy. A qualitative vascular response was seen in 24 patients (31%). Combination chemotherapy yields a response rate of 24% and a clinical benefit rate (CR/PR/SD > 6 months) of 44%, higher than previously reported in DD liposarcoma. A higher percentage of patients experience a vascular response with chemotherapy that is not adequately captured by RECIST in these large heterogeneous tumors.

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