Presurgical Immunotherapy May Improve Survival in Certain Sarcomas

Patients with certain sarcomas who received neoadjuvant (treatment before surgery) immunotherapy tended to have promising long-term survival, according to a news release from The University of Texas MD Anderson Cancer Center.

Results from a phase 2 trial, published in the journal, Nature Cancer, found that treatment with a combination of immunotherapy and radiation before surgical removal of the residual mass benefited 90% of patients with undifferentiated pleomorphic sarcoma (UPS). More specifically, researchers noted that this patient population had less than 15% viable tumor cells after treatment, which determined that the immunotherapy-radiation combination showed better results than radiation alone.

The current treatment options for UPS are radiation therapy and chemotherapy to reduce the risk of cancer recurrence, the news release stated.

UPS is a type of cancer that forms in the soft tissue and may form in bone, the National Cancer Institute defines. Although UPS can form anywhere in the body, the most common areas include the legs (mostly the thigh area), arms or the back of the abdomen. This type of cancer is known to grow and spread quickly throughout the body, but especially to the lungs.

The trial included 27 patients with UPS (10 patients) or dedifferentiated liposarcoma (DDLPS; 17 patients).

All patients were randomly assigned to one of four treatment arms: two that were immunotherapy only and two that were immunotherapy plus radiation therapy, according to the listing on Clinical Trials.gov. The four arms included Opdivo alone; Opdivo plus Yervoy; Opdivo plus radiation therapy; and Opdivo plus Yervoy with radiation therapy.

“These results demonstrate the role immunotherapy treatment can have on soft-tissue sarcomas and how the neoadjuvant treatment platform can help identify novel treatment options for patients,” Dr. Christina Roland, co-principal investigator of the study and associate professor of surgical oncology at MD Anderson Cancer Center, said in the news release. “Sarcoma patients have limited systemic therapy options to consider, and this trial offers data to support the use of immunotherapy in their treatment.”

The trial seeks to evaluate several endpoints (results measured at the end of a study to see if treatment worked), including the primary endpoint of pathologic responses (how much cancer remains in tissue samples after treatment) for the four treatment types in the study.

Regardless of the treatment arm, all patients in the study underwent surgical resection for their tumors after receiving immunotherapy, in which the tissue samples were evaluated. Researchers found that improved OS was because of the presence of intratumoral B cells.

“Trial participant biopsies were examined at various stages throughout to assess and examine B cells,” Dr. Neeta Somaiah, co-principal investigator and associate professor of sarcoma medical oncology at MD Anderson Cancer Center, said in the news release. “We know from previous research the importance of the presence of B cells in a tumor to predict immunotherapy responses, and we found in this study that patients with higher levels of B cells in their tumors were more likely to respond.”

Three of the secondary endpoints include objective response rate (percentage of patients who have a partial or complete response to treatment), overall survival (OS; time from diagnosis or start of treatment when patients with cancer are still alive) and recurrence-free survival (length of time patients with cancer live without cancer returning).

Of note, the trial found that the rate of OS two years after their first treatment was 82% in patients with resectable (surgically removable) retroperitoneal DDLPS and 90% in patients with UPS.

The safety and side effects that were observed were determined to be manageable, according to the news release, and all patients in the study did not have an increased risk of surgery complications and/or new side effects.

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