Liposarcoma

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Note: these are regimens tested in subtype-specific populations, please see the main soft tissue sarcoma page for other regimens.
Last updated on 2024-09-06:4 regimens on this page
6 variants on this page
=Guidelines=
Given the rapid change in evidence in many areas of hematology/oncology, readers are encouraged to consider any guideline published 5+ years ago to be for historical purposes, only.
==NCCN==
*NCCN does not currently have guidelines at this granular level; please see NCCN Guidelines - Soft Tissue Sarcoma.
=Advanced or metastatic disease, subsequent lines of therapy=
==Dacarbazine monotherapy==
===Regimen variant #1, 850 mg/m2===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Schöffski et al. 2016 (E7389-G000-309)	2011-2013 	Phase 3 (C)	Eribulin 	Shorter OS1
1Reported efficacy is based on the 2017 subgroup analysis.
====Chemotherapy====
*Dacarbazine (DTIC) 850 mg/m2 IV over 20 to 120 minutes once on day 1
21-day cycles
===Regimen variant #2, 1000 mg/m2===
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Demetri et al. 2015 (ET743-SAR-3007) 	2011-2013 	Phase 3 (C)	Trabectedin	Did not meet primary endpoint of OS
Schöffski et al. 2016 (E7389-G000-309)	2011-2013 	Phase 3 (C)	Eribulin 	Shorter OS1
1Reported efficacy is based on the 2017 subgroup analysis.
Note: this is listed as a "starting dose" in Demetri et al. 2015, but no adjustment instructions were provided in the manuscript.
====Chemotherapy====
*Dacarbazine (DTIC) 1000 mg/m2 IV over 20 to 120 minutes once on day 1
21-day cycles
===Regimen variant #3, 1200 mg/m2===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Schöffski et al. 2016 (E7389-G000-309)	2011-2013 	Phase 3 (C)	Eribulin 	Shorter OS1
1Reported efficacy is based on the 2017 subgroup analysis.
====Chemotherapy====
*Dacarbazine (DTIC) 1200 mg/m2 IV over 20 minutes once on day 1
====Supportive therapy====
*Buesa et al. 1991: Calcium gluconate (10% solution) 5 mL IV every 10 minutes x 3 doses (total of 15 mL) after the start of dacarbazine; 2 additional doses of calcium gluconate (10% solution) 5 mL IV every 10 minutes were given to patients whose systolic blood pressure decreased below 80 mmHg or heart rate more than 160 bpm.
21-day cycles
===References===
# ET743-SAR-3007: Demetri GD, von Mehren M, Jones RL, Hensley ML, Schuetze SM, Staddon A, Milhem M, Elias A, Ganjoo K, Tawbi H, Van Tine BA, Spira A, Dean A, Khokhar NZ, Park YC, Knoblauch RE, Parekh TV, Maki RG, Patel SR. Efficacy and safety of trabectedin or dacarbazine for metastatic liposarcoma or leiomyosarcoma after failure of conventional chemotherapy: results of a phase III randomized multicenter clinical trial. J Clin Oncol. 2016 Mar 10;34(8):786-93. Epub 2015 Sep 14. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01343277
## Subgroup analysis: Hensley ML, Patel SR, von Mehren M, Ganjoo K, Jones RL, Staddon A, Rushing D, Milhem M, Monk B, Wang G, McCarthy S, Knoblauch RE, Parekh TV, Maki RG, Demetri GD. Efficacy and safety of trabectedin or dacarbazine in patients with advanced uterine leiomyosarcoma after failure of anthracycline-based chemotherapy: Subgroup analysis of a phase 3, randomized clinical trial. Gynecol Oncol. 2017 Sep;146(3):531-537. Epub 2017 Jun 24. link to original article link to PMC article EuroPMC
## Update: Patel S, von Mehren M, Reed DR, Kaiser P, Charlson J, Ryan CW, Rushing D, Livingston M, Singh A, Seth R, Forscher C, D'Amato G, Chawla SP, McCarthy S, Wang G, Parekh T, Knoblauch R, Hensley ML, Maki RG, Demetri GD. Overall survival and histology-specific subgroup analyses from a phase 3, randomized controlled study of trabectedin or dacarbazine in patients with advanced liposarcoma or leiomyosarcoma. Cancer. 2019 Aug 1;125(15):2610-2620. Epub 2019 Jun 7. link to original article link to PMC article EuroPMC
# E7389-G000-309: Schöffski P, Chawla S, Maki RG, Italiano A, Gelderblom H, Choy E, Grignani G, Camargo V, Bauer S, Rha SY, Blay JY, Hohenberger P, D'Adamo D, Guo M, Chmielowski B, Le Cesne A, Demetri GD, Patel SR. Eribulin versus dacarbazine in previously treated patients with advanced liposarcoma or leiomyosarcoma: a randomised, open-label, multicentre, phase 3 trial. Lancet. 2016 Apr 16;387(10028):1629-37. Epub 2016 Feb 10. link to original article EuroPMC NCT01327885
## Subgroup analysis: Demetri GD, Schöffski P, Grignani G, Blay JY, Maki RG, Van Tine BA, Alcindor T, Jones RL, D'Adamo DR, Guo M, Chawla S. Activity of eribulin in patients with advanced liposarcoma demonstrated in a subgroup analysis from a randomized phase III study of eribulin versus dacarbazine. J Clin Oncol. 2017 Oct 20;35(30):3433-3439. Epub 2017 Aug 30. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
==Eribulin monotherapy==
===Regimen===
FDA-recommended dose
Study 	Dates of enrollment	Evidence 	Comparator 	Comparative Efficacy
Schöffski et al. 2016 (E7389-G000-309)	2011-2013 	Phase 3 (E-RT-switch-ic)	Dacarbazine	Longer OS1 (primary endpoint)Median OS: 15.6 vs 8.4 mo(HR 0.51, 95% CI 0.35-0.75)
1Reported efficacy is based on the 2017 subgroup analysis.
====Chemotherapy====
*Eribulin (Halaven) 1.4 mg/m2 IV once per day on days 1 & 8
21-day cycles
===References===
# E7389-G000-309: Schöffski P, Chawla S, Maki RG, Italiano A, Gelderblom H, Choy E, Grignani G, Camargo V, Bauer S, Rha SY, Blay JY, Hohenberger P, D'Adamo D, Guo M, Chmielowski B, Le Cesne A, Demetri GD, Patel SR. Eribulin versus dacarbazine in previously treated patients with advanced liposarcoma or leiomyosarcoma: a randomised, open-label, multicentre, phase 3 trial. Lancet. 2016 Apr 16;387(10028):1629-37. Epub 2016 Feb 10. link to original article dosing details in abstract have been reviewed by our editors EuroPMC NCT01327885
## Subgroup analysis: Demetri GD, Schöffski P, Grignani G, Blay JY, Maki RG, Van Tine BA, Alcindor T, Jones RL, D'Adamo DR, Guo M, Chawla S. Activity of eribulin in patients with advanced liposarcoma demonstrated in a subgroup analysis from a randomized phase III study of eribulin versus dacarbazine. J Clin Oncol. 2017 Oct 20;35(30):3433-3439. Epub 2017 Aug 30. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
==Selinexor monotherapy==
===Regimen===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Gounder et al. 2022 (SEAL)	Not reported 	Phase 3 (E-esc)	Placebo 	Longer PFS (primary endpoint)Median PFS: 2.8 vs 2.1 mo(HR 0.70, 95% CI 0.52-0.95)
====Targeted therapy====
*Selinexor (Xpovio) 60 mg PO once per day on days 1, 4, 8, 11, 15, 18, 22, 25, 29, 32, 36, 39
42-day cycles
===References===
#SEAL: Gounder MM, Razak AA, Somaiah N, Chawla S, Martin-Broto J, Grignani G, Schuetze SM, Vincenzi B, Wagner AJ, Chmielowski B, Jones RL, Riedel RF, Stacchiotti S, Loggers ET, Ganjoo KN, Le Cesne A, Italiano A, Garcia Del Muro X, Burgess M, Piperno-Neumann S, Ryan C, Mulcahy MF, Forscher C, Penel N, Okuno S, Elias A, Hartner L, Philip T, Alcindor T, Kasper B, Reichardt P, Lapeire L, Blay JY, Chevreau C, Valverde Morales CM, Schwartz GK, Chen JL, Deshpande H, Davis EJ, Nicholas G, Gröschel S, Hatcher H, Duffaud F, Herráez AC, Beveridge RD, Badalamenti G, Eriksson M, Meyer C, von Mehren M, Van Tine BA, Götze K, Mazzeo F, Yakobson A, Zick A, Lee A, Gonzalez AE, Napolitano A, Dickson MA, Michel D, Meng C, Li L, Liu J, Ben-Shahar O, Van Domelen DR, Walker CJ, Chang H, Landesman Y, Shah JJ, Shacham S, Kauffman MG, Attia S. Selinexor in Advanced, Metastatic Dedifferentiated Liposarcoma: A Multinational, Randomized, Double-Blind, Placebo-Controlled Trial. J Clin Oncol. 2022 Aug 1;40(22):2479-2490. Epub 2022 Apr 8. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02606461
==Trabectedin monotherapy==
===Regimen===
Study 	Dates of enrollment 	Evidence 	Comparator 	Comparative Efficacy
Demetri et al. 2009 	2003 to not reported	Randomized Phase 2 (E-switch-ic)	Trabectedin; alternate schedule	Seems to have longer TTP (primary endpoint)Median TTP: 3.7 vs 2.3 mo(HR 0.73, 95% CI 0.55-0.97)
Demetri et al. 2015 (ET743-SAR-3007)	2011-2013 	Phase 3 (E-RT-switch-ic) 	Dacarbazine 	Did not meet primary endpoint of OS
Note: in Demetri et al. 2015, this is listed as a "starting dose," but no adjustment instructions were provided in the manuscript.
====Chemotherapy====
*Trabectedin (Yondelis) 1.5 mg/m2 IV continuous infusion over 24 hours, started on day 1
====Supportive therapy====
*Dexamethasone (Decadron) 20 mg IV once on day 1, prior to trabectedin
21-day cycles
===References===
# Demetri GD, Chawla SP, von Mehren M, Ritch P, Baker LH, Blay JY, Hande KR, Keohan ML, Samuels BL, Schuetze S, Lebedinsky C, Elsayed YA, Izquierdo MA, Gómez J, Park YC, Le Cesne A. Efficacy and safety of trabectedin in patients with advanced or metastatic liposarcoma or leiomyosarcoma after failure of prior anthracyclines and ifosfamide: results of a randomized phase II study of two different schedules. J Clin Oncol. 2009 Sep 1;27(25):4188-96. Epub 2009 Aug 3. link to original article dosing details in abstract have been reviewed by our editors EuroPMC
# ET743-SAR-3007: Demetri GD, von Mehren M, Jones RL, Hensley ML, Schuetze SM, Staddon A, Milhem M, Elias A, Ganjoo K, Tawbi H, Van Tine BA, Spira A, Dean A, Khokhar NZ, Park YC, Knoblauch RE, Parekh TV, Maki RG, Patel SR. Efficacy and safety of trabectedin or dacarbazine for metastatic liposarcoma or leiomyosarcoma after failure of conventional chemotherapy: results of a phase III randomized multicenter clinical trial. J Clin Oncol. 2016 Mar 10;34(8):786-93. Epub 2015 Sep 14. link to original article dosing details in manuscript have been reviewed by our editors link to PMC article EuroPMC NCT01343277
## Subgroup analysis: Hensley ML, Patel SR, von Mehren M, Ganjoo K, Jones RL, Staddon A, Rushing D, Milhem M, Monk B, Wang G, McCarthy S, Knoblauch RE, Parekh TV, Maki RG, Demetri GD. Efficacy and safety of trabectedin or dacarbazine in patients with advanced uterine leiomyosarcoma after failure of anthracycline-based chemotherapy: Subgroup analysis of a phase 3, randomized clinical trial. Gynecol Oncol. 2017 Sep;146(3):531-537. Epub 2017 Jun 24. link to original article link to PMC article EuroPMC
## Update: Patel S, von Mehren M, Reed DR, Kaiser P, Charlson J, Ryan CW, Rushing D, Livingston M, Singh A, Seth R, Forscher C, D'Amato G, Chawla SP, McCarthy S, Wang G, Parekh T, Knoblauch R, Hensley ML, Maki RG, Demetri GD. Overall survival and histology-specific subgroup analyses from a phase 3, randomized controlled study of trabectedin or dacarbazine in patients with advanced liposarcoma or leiomyosarcoma. Cancer. 2019 Aug 1;125(15):2610-2620. Epub 2019 Jun 7. link to original article link to PMC article EuroPMC
Category:Liposarcoma regimens
Category:Disease-specific pages
Category:Soft tissue sarcomas