Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: a single-insti
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RESEARCH ARTICLE
Open Access
Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: a single-institution retrospective analysis Shiro Saito1, Hisaki Aiba1* , Satoshi Yamada1, Hideki Okamoto1, Katsuhiro Hayashi1,2, Hiroaki Kimura1,2, Shinji Miwa1,2, Takanobu Otsuka1,3 and Hideki Murakami1
Abstract Background: The standard chemotherapy regimens for soft tissue sarcoma are doxorubicin-based. This retrospective study aimed to assess the efficacy and safety of pirarubicin, ifosfamide, and etoposide combination therapy for patients with this disease. Methods: Between 2008 and 2017, 25 patients with soft tissue sarcoma were treated with pirarubicin (30 mg/m2, 2 days), ifosfamide (2 g/m2, 5 days), and etoposide (100 mg/m2, 3 days) every 3 weeks. The primary endpoint was overall response, and the secondary endpoint was adverse events of this regimen. Results: Responses to this regimen according to RECIST criteria were partial response (n = 9, 36%), stable disease (n = 9, 36%) and progressive disease (n = 7, 28%). During the treatment phase, frequent grade 3 or worse adverse events were hematological toxicities including white blood cell decreases (96%), febrile neutropenia (68%), anemia (68%), and platelet count decreases (48%). No long-term adverse events were reported during the study period. Conclusion: This regimen was comparable to previously published doxorubicin-based combination chemotherapy in terms of response rate. Although there were no long-lasting adverse events, based on our results, severe hematological toxicity should be considered. Keywords: Chemotherapy, Pirarubicin, Ifosfamide, Etoposide, Soft tissue sarcoma
Background Soft tissue sarcomas are malignant tumors that can originate in soft tissues throughout the body; they comprise approximately 0.7% of all adult malignant tumors [1]. The definitive therapy for localized soft tissue sarcomas is surgical excision, whereas chemotherapy is administered to patients with metastases or unresectable lesions to prolong survival or delay * Correspondence: [email protected] 1 Department of Orthopedic Surgery, Nagoya City University Graduate School of Medical Sciences, 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Aichi 467-8601, Japan Full list of author information is available at the end of the article
cancer progression. Doxorubicin (Adriamycin [ADR]) monotherapy remains the standard first-line regimen for patients with advanced soft tissue sarcomas, although the effectiveness of this treatment is not high [2, 3]. Pirarubicin (4′-O-tetrahydropyranyl doxorubicin [THP]) is an anthracycline antineoplastic antibiotic discovered by Umezawa et al. that can act as a substitute for ADR [4]. THP inhibits DNA synthesis by interacting with topoisomerase II, thereby exhibiting an antitumor effect. In past studies, the uptake velocity of THP was found to be approximately 170 times faster than that of ADR, while its cardiotoxicity was lower [5, 6].
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