The development of olaratumab marks the latest breakthrough in an ongoing effort to find better treatments for STS. Until now, the standard second-line treatment of STS has been fixed-dose-rate gemcitabine with or without docetaxel. Additional second-line treatments are being investigated as well; 2 second-line treatments were approved by the FDA in the past year.

Shreyaskumar R Patel, MD, and Ravin Ratan, MD, of the University of Texas MD Anderson Cancer Center in Houston, Texas, reviewed the recent developments in treatment of STS in Cancer. In the review, they note that until now, doxorubicin and ifosfamide have been the most effective chemotherapy agents for treating the disease.2

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In an email to Cancer Therapy Advisor, Dr Patel said that he thinks the most important development in STS treatment in the last decade has been the recognition that STS comprises of a group of diverse diseases that require histology-based clinical investigations. He noted that the development and approval of the drugs pazopanib, trabectedin and eribulin in the past 5 years is very important.

“Acceptance of new drugs in front-line will depend on the amount of improved benefit in their relative risk, progression-free survival, and overall survival over the current standard,” he said. “Other factors include toxicity profile and cost.” Over the next 10 years, he said that while he doubts the current standard of care drugs will be eclipsed, “it’s likely that we will nibble away slowly but surely at many of the histologic subsets with better or less toxic therapies.”

In the review, Drs Patel and Ratan contend that adjuvant therapy is “reasonable” and write that “we believe that well-conducted meta-analyses provide sufficient evidence to support its use.” They also write that with regard to second-line, third-line, and fourth-line therapies, “the identification of differential responses based on the sarcoma subtype [would allow] us to better tailor our treatments to patients’ specific histologies.”

In addition to olaratumab, the FDA has approved 2 new second-line treatments in the past year. Yondelis (trabectedin) was approved in October 2015 for treatment of unresectable or metastatic liposarcoma and leiomyosarcoma in patients previously treated with chemotherapy that contained anthracycline.4 Halaven (eribulin mesylate) was approved in January 2016 for treatment of unresectable or metastatic liposarcoma in patients who were also treated with anthracycline chemotherapy.5