Dr. Tseng on Role of Neoadjuvant Systemic Therapy in High-Risk Retroperitoneal Sarcoma

William W. Tseng, MD, a sarcoma surgeon with Keck Medicine of University of Southern California, discusses the potential role of neoadjuvant systemic therapy in high-risk retroperitoneal sarcoma (RPS).

In this retrospective study, investigators collected clinicopathologic data on eligible patients treated from 2008 to 2018 at 13 institutions within the Transatlantic Australasian Retroperitoneal Sarcoma Working Group.

A total of 158 patients were enrolled on the study, and they were treated with a median of 3 cycles of neoadjuvant systemic therapy; just under half, or 46%, of patients also received neoadjuvant radiation therapy. Results showed that 23% of patients experienced a partial response with this approach and 56% achieved stable disease.

Twenty-one percent of patients experienced disease progression. In terms of clinical outcomes, the most significant finding, according to Tseng, was that patients with progressive disease had worse outcomes. Specifically, these patients had 2.7-fold lower overall survival than those whose disease did not progress, adds Tseng.

The results indicate that the response to neoadjuvant systemic therapy could be used as a potential indicator of disease biology to predict outcome following surgery, explains Tseng.

The results from the study also raise the question of whether patients with progressive disease, and thus, worse survival, should receive second-line treatment. Surgery can be very challenging and the recovery can be difficult for patients. If a patient’s survival is poor, Tseng posits trying another type of therapy, but the topic is still under discussion.