Roman Groisberg, MD, Medical Oncologist and Director of the Sarcoma Program at Rutgers Cancer Institute of New Jersey/RWJBarnabas Health, discusses treatment options available for different sarcomas.

Sarcomas are rare cancers that develop in the bones and soft tissues, including fat, muscles, blood vessels, nerves, deep skin tissues and fibrous tissues. According to the National Cancer Institute, about 12,000 cases of soft tissue sarcomas and 3,000 cases of bone sarcomas are diagnosed in the U.S. each year. Bone sarcomas are more common among children while soft tissue sarcomas are more common in adults.

As Dr. Groisberg explains, there are two main regimens used to treat bone sarcomas: 1) a combination known as the Ewing regimen which involves vincristine, adriamycin, cyclophosphamide (VAC), alternating with ifosfamide and etoposide (IE); and 2) the MAP regimen (methotrexate + cisplatin + doxorubicin) which is typically used for osteosarcoma. 

For soft tissue sarcomas, treatment typically involves chemotherapies like doxorubicin or adriamycin. These chemotherapies are used in many cancers; however, Dr. Groisberg cautions that with sarcomas, the dose often needs to be higher (e.g., 75 mg/m2 compared to the standard 60 mg/m2). Some oncologists supplement doxorubicin with doxorubicin liposomal (Doxil) or with pegylated liposomal doxorubicin. However, the dose of Doxil can not be increased the way doxorubicin can, which makes it, in Dr. Groisberg’s opinion, a less effective treatment method. Ifosfamide is another potent treatment option for sarcomas. Pushing higher doses of ifosfamide can be dangerous though, especially for older patients as it can cause neurotoxicity and/or nephrotoxicity. Nevertheless for synovial sarcomas, ifosfamide is one of the most effective drugs available. Next line drugs for sarcomas include: gemcitabine, trabectedin, and pazopanib.

Additionally, there are a few targeted therapies that have been approved for specific sarcoma subtypes. 

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