1. Notes from BSG 2019 London
Some observations

2. 2 full days, 80 posters, 23 free papers Clinical Trials Update
Sarcoma Service Updates
(SACT, Proton, NHS E)
Unusual cases(Epithelioid, Clear Cell, PEComa)
Case based discussions
Guest Lectures
– Immunotherapy overview, Retroperitoneal surgery, Best practice in rehab.
Topics; Spinal sarcomas, MDT improvements, Adj chemo, Fibromatosis, GIST.

3. Olaratumab Noticable by its absence!
PDGFRa inhibitor, monoclonal antibody
Initial randomised phase 2 trial had stunning survival advantage.
133 patients
OS at 12 months: 14.7 months v 26.5 months
PFS median: 4 months v 6 months

4. Olaratumab Phase 3 trial ANNOUNCE Reported Jan 2019
No difference in Overall Survival
No safety concerns
No benefit to patients continuing
No Results expected for a year

5. Consider: PS 0-1 Under 65 yrs (45 yrs) 20 cm thigh tumour Grade 3
MFH/UPS
Wide resection, clear margins
Also getting Radiotherapy

6. Predicted outcome - Sarculator
If aged 45
10 yr OS = 51% (30% Persarc)
10yr DM = 58%

7. Italian papers 3 v 5 courses (Ifos 9, Epi 120) EORTC 62931
Lancet Oncology 2012, 13, (10)
Adj chemo (Ifos/Adria) v nil
Completely resected limb/trunk high risk STS
No difference between 2 groups

8. Italian group – different chemo for different pathology, nothing beats Ifos/Anthracycline
Pasquali EJC 2019, 109, 51-60
Based on re analysis of EORTC 62931
Used Sarculator to assign into:
Poor 10 year OS (<51%)
Medium and Good 10 yr OS
Compared effect of chemo or no chemo

9. For the poor risk group chemo halved the risk of recurrence or death
Pasquali EJC 2019, 109, 51-60
For the poor risk group chemo halved the risk of recurrence or death
Suggested - increase OS by 21% at 8 yrs
Need to treat 5 to benefit 1
Those at greatest risk benefit most

10. Concerns: What is the cost and morbidity/mortality
In-patient chemo, central access, longer until return to work
Risk of serious events (death) – in EORTC study – same, except more infection in control group.
40% grade haematological event

11. Chemotherapy doses Ifos 5/Adriamycin 75
(used in EORTC study, Ifos dose criticised)
Italian (Ifos 9 / Epirubicin 120)
Should it be Ifos 9 plus Adriamycin 50-75??

12. Will need to have SSN view on this
Propose to discuss this in September meeting
To agree who should be offered this
How we will deliver
Doses, drugs and number of courses
Sequencing with surgery and RT

13. Measurable Outcomes (Like our QPI) From the MDT meeting or record
Have they seen a CNS
Has PS been documented
? TNM
Have they had written and verbal info
HNA in line with recovery package

14. Key worker / CNS
Not part of ‘QPI’, if it was – how would it be ‘measured’
Can we demo that each region has good coverage – geographical and tumour type
Not all (eg) breast cancer pts now have a CNS

15. Managing Expectations
For outcomes
Function
Survival
For access to
Drugs (chemo, immuno, cannabis)
Investigations / New technologies
Personalised medicine / drugable targets

16. Genomic Sequencing What is it going to be What consent is required
What samples are needed
How long to get a report
What difference will a report make
Need for ‘genomic ‘MDTs’
GeCIP (Genomics England Clinical Interpretation Partnership)

17. GIST – S Bauer Heat maps, molecular analysis, surgical options
Necrosis is bad
Intermediate risk with necrosis as bad as a high risk
High risk with necrosis worse again
Ablative RT for rectal GIST to avoid surgery
Large gastric GIST
may benefit from 9-12 mo pre op imatinib

18. Fibromatosis Desmoid Global Consensus ? Publication this year
Mutational analysis on all specimens
CTNNB1 mutations and APC mutations are mutually exclusive

19. Fibromatosis All patients should have ‘active surveillance’ initially
Unless life threatening or critical anatomical site
Move to therapy should be:
After at least 2 further assessments
At least a year from diagnosis
Progression of tumour and / or increasing symptoms

20. Fibromatosis Abdominal Wall Extremity, Chest wall, Girdles
Surgery 1st option
Extremity, Chest wall, Girdles
Only surgery if very low morbidity
Otherwise Medical therapy
Intrabdominal, Retroperitoneal, Pelvic
Consider systemic therapy as first option

21. Fibromatosis
FAP associated Desmoid tends to be more aggressive and multifocal

22. Fibromatosis
Drugs / combinations may not have evidence of a good level
Tamoxifen, Calyx, DTIC
Only randomised data exists for
Sorefanib, pazopanib and MTX/VBL
Phase II data
Imatinib
Suggest start with least toxic, and work up

23. Random observations Sunitinib for Solitary Fibrous Tumour
TKI in osteosarocma – possibly with conventional chemo
Brachyuri
NYES01 in Synovial sarcoma and Myxoid sarcoma – may be a target / immuno option
RMH immunocore phase 1 study

24. Random observations Chondrosarcoma Leiomyosarcoma
De differentiated, may be an immunological mech
Leiomyosarcoma
Gem or Gem/DTIC
Often first choice

25. High dose in Ewings In relapse / refractory disease Selected cases
Best if just localised disease +/- lung
More aggressive trt at relapse
Suggested median efs 84 mo v 10 mo

26. There were many other interesting posters and talks
Try to come get involved in and attend BSG 2020
Glasgow 26th and 27th February 2020