Epidemiology and therapies for metastatic sarcoma

Abstract

Sarcomas are cancers arising from the mesenchymal layer that affect children, adolescents, young adults, and adults. Although most sarcomas are localized, many display a remarkable predilection for metastasis to the lungs, liver, bones, subcutaneous tissue, and lymph nodes. Additionally, many sarcoma patients presenting initially with localized disease may relapse at metastatic sites. While localized sarcomas can often be cured through surgery and often radiation, controversies exist over optimal management of patients with metastatic sarcoma. Combinations of chemotherapy are the most effective in many settings, and many promising new agents are under active investigation or are being explored in preclinical models. Metastatic sarcomas are excellent candidates for novel approaches with additional agents as they have demonstrated chemosensitivity and affect a portion of the population that is motivated toward curative therapy. In this paper, we provide an overview on the common sarcomas of childhood (rhabdomyosarcoma), adolescence, and young adults (osteosarcoma, Ewing sarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor) and older adults (leiomyosarcoma, liposarcoma, and undifferentiated high grade sarcoma) in terms of the epidemiology, current therapy, promising therapeutic directions and outcome with a focus on metastatic disease. Potential advances in terms of promising therapy and biologic insights may lead to more effective and safer therapies; however, more clinical trials and research are needed for patients with metastatic sarcoma.

Keywords:

• chemotherapy
• pediatric sarcoma
• rhabdomyosarcoma
• osteosarcoma
• Ewing sarcoma
• synovial sarcoma

Acknowledgment

We thank Rasa Hamilton (Moffitt Cancer Center) for editorial assistance.

Disclosure

Ernest Amankwah is supported by a cancer prevention fellowship from the National Cancer Institute (grant R25T CA147832). Anthony Conley serves as a consultant for Novartis Pharmaceuticals. Damon Reed receives support from the Pediatric Cancer Foundation, the Gonzmart Family Foundation, Swim Across America, and the Moffitt Cancer Center Sarcoma Foundation. No significant relationship exists between the authors and the companies/organizations whose products or services may be referenced in this article. The authors report no other conflicts of interest in this work.