1. Soft tissue sarcoma treatment: Results from the drug shortage era
M. Salamoon(1), T. Hussein(2), F. Ahmad(3), M. Daghlawi(3), M. Nassar(3), A. Mahmoud(4), M. Bachour(5) (1)Bairouni University Hospital, Damascus, Syria (2)Tishreen Hospital, Pathology, Damascus, Syria (3)Bairouni University Hospital, Pathology, Damascus, Syria (4)Bairouni University Hospital, Soft Tissue Sarcoma Department, Damascus, Syria (5)Bairouni University Hospital, Medical Oncology Department, Damascus, Syria
Results and discussion: 236 patients were included in the study, 87 patients of which presented with metastatic disease (pulmonary, osseous and abdominal). Evaluation after 3 cycles revealed a complete response in 62 out of 87 (71%) with a P.value of 0.72, while only 34 out of 149 (22%) became resectable after neoadjuvant chemotherapy with a P.value of 0.87.
Conclusions: Results showed that the new combination of ifosfamide and cisplatin seems to be a good choice in metastatic soft tissue sarcomas even a larger number of patients is needed to confirm such results. However, the same combination showed to have a poor efficacy on locally advanced soft tissue sarcomas raising the issue of drug shortage as a negative factor on such disease. Furthermore, this study should alert health professional worldwide to the risk lying behind drug shortage in developing countries and to some extent in developed ones and its negative impact on cancer treatment.
Background: Soft tissue sarcomas are mesodermal malignancies affecting trunk, extremities and abdomen. As a group, it is treated by surgery whenever it is possible; otherwise, chemotherapy is applied using a combination of ifosfamide and anthracyclines.
Objective: The objective of this study was to evaluate the impact of drug shortage (anthracyclines in our study) on response rate especially in locally advanced and metastatic disease.
Material and Methods: The study was done at Al Bairouni University Hospital in Damascus (SYRIA). In 2012, there was a shortage of doxorubicine, therefore the former agent was replaced by cisplatin in combination with ifosfamide. The new combination was: ifosfamide 2gr/m2 × 3 days + cisplatin 35mg/m2 X 3 days with G-csf support given for 3 cycles every 21 days. The former combination was employed for both neoadjuvant setting and metastatic disease. Patients were evaluated by means of CT-Scan, MRI and physical exam.
P-value
Responders
Patients
0.87 34
149
Neoadjuvant
0.72 62 87
Metastatic