Soft Tissue Sarcoma Subtypes: Liposarcoma and Leiomyosarcoma

Leiomyosarcoma

Classified as uterine or nonuterine

Leiomyosarcoma classified as uterine or nonuterine accounts for approximately 24% of soft tissue sarcomas in adults

of soft tissue sarcomas in adults.^*¹

Read about a patient with leiomyosarcoma.

Liposarcoma

Liposarcoma accounts for approximately 12% of soft tissue sarcomas in adults Subtypes²
Myxoid/Round Cell
Well-differentiated
Pleomorphic
Dedifferentiated

of soft tissue sarcomas in adults.^*¹

^*Percentages based on incidence data from 1978-2001 collected in the 9 Surveillance, Epidemiology and End Results (SEER) program areas. Cases of soft tissue sarcoma were categorized into major histologic types and subtypes, according to criteria specified in the 2002 World Health Organization Classification of Tumours and the recommendations of an expert pathologist. Additional cases that met the morphologic criteria of soft tissue sarcoma regardless of primary site, except bones and joints, were added for a total of 26,758 cases used in the analysis.

Explore liposarcoma case studies.

Treating patients with unresectable or metastatic leiomyosarcoma or liposarcoma

Treatment considerations should include tumor characteristics³:

Treatment

Chemosensitivity of histological subtype³
Natural history³
Tumor burden³
Tumor stage⁴
Tumor grade⁴

Clinical characteristics³:

Clinical

Patient’s general condition and level of symptoms³
Comorbidities³
Previous treatments³
Patient goals³

Read about treating patients with leiomyosarcoma.

Delaying disease progression is one measure of treatment success in advanced soft tissue sarcoma⁵

Progression-free survival (PFS) is the time from randomization to objective tumor progression or death.⁵

PFS

PFS allows new treatments to be evaluated in smaller studies and over shorter periods of time, and results are not confounded by subsequent lines of therapy.⁵

Explore a treatment option for
liposarcoma and leiomyosarcoma.

Consider YONDELIS^®

YONDELIS^® is the only treatment recently approved specifically for unresectable or metastatic liposarcoma or leiomyosarcoma after an anthracycline-containing regimen.

Read about the efficacy of YONDELIS^®.

References:

Toro JR, Travis LB, Wu HJ, Zhu K, Fletcher CDM, Devesa SS. Incidence patterns of soft tissue sarcomas, regardless of primary site, in the Surveillance, Epidemiology and End Results program, 1978-2001: an analysis of 26,758 cases. Int J Cancer. 2006;119(12):2922-2930.
Henze J, Bauer S. Liposarcomas. Hematol Oncol Clin N Am. 2013;27(5):939-955.
Blay J-Y, Sleijfer S, Schöffski P, et al. International expert opinion on patient-tailored management of soft tissue sarcomas. Eur J Cancer. 2014;50(4):679-689.
Grimer R, Judson I, Peake D, Seddon D. Guidelines for the management of soft tissue sarcomas. Sarcoma. 2010;2010:506182. doi:10.1155/2010/506182.
Chmielowski B, Federman N, Tap WD. Clinical trial end points for assessing efficacy of novel therapies for soft-tissue sarcomas. Expert Rev Anticancer Ther. 2012;12(9):1217–1228.

CONTRAINDICATIONS — YONDELIS^® (trabectedin) is contraindicated in patients with known severe hypersensitivity, including anaphylaxis, to trabectedin.

WARNINGS AND PRECAUTIONS

Neutropenic sepsis, including fatal cases, can occur. In Trial 1, the incidence of Grade 3 or 4 neutropenia, based on laboratory values, was 43% (161/378). Median time to the first occurrence of Grade 3 or 4 neutropenia was 16 days (range: 8 days to 9.7 months). Median time to complete resolution of neutropenia was 13 days (range: 3 days to 2.3 months). Febrile neutropenia (fever ≥38.5°C with Grade 3 or 4 neutropenia) occurred in 18 patients (5%). Ten patients (2.6%) experienced neutropenic sepsis, 5 of whom had febrile neutropenia, which was fatal in 4 patients (1.1%). Assess neutrophil count prior to administration of each dose of YONDELIS^® and periodically throughout the treatment cycle. Withhold YONDELIS^® for neutrophil counts of less than 1500 cells/microliter on the day of dosing. Permanently reduce the dose of YONDELIS^® for life-threatening or prolonged, severe neutropenia in the preceding cycle.

Rhabdomyolysis — YONDELIS^® can cause rhabdomyolysis and musculoskeletal toxicity. In Trial 1, rhabdomyolysis leading to death occurred in 3 (0.8%) of the 378 patients. Elevations in creatine phosphokinase (CPK) occurred in 122 (32%) of the 378 patients receiving YONDELIS^®, including Grade 3 or 4 CPK elevation in 24 patients (6%), compared to 15 (9%) of the 172 patients receiving dacarbazine with any CPK elevation, including 1 patient (0.6%) with Grade 3 CPK elevation. Among the 24 patients receiving YONDELIS^® with Grade 3 or 4 CPK elevation, renal failure occurred in 11 patients (2.9%); rhabdomyolysis with the complication of renal failure occurred in 4 of these 11 patients (1.1%). Median time to first occurrence of Grade 3 or 4 CPK elevations was 2 months (range: 1 to 11.5 months). Median time to complete resolution was 14 days (range: 5 days to 1 month). Assess CPK levels prior to each administration of YONDELIS^®. Withhold YONDELIS^® for serum CPK levels more than 2.5 times the upper limit of normal. Permanently discontinue YONDELIS^® for rhabdomyolysis.

Hepatotoxicity, including hepatic failure, can occur. Patients with serum bilirubin levels above the upper limit of normal or AST or ALT levels >2.5 × ULN were not enrolled in Trial 1. In Trial 1, the incidence of Grade 3-4 elevated liver function tests (defined as elevations in ALT, AST, total bilirubin, or alkaline phosphatase) was 35% (134/378). Median time to development of Grade 3-4 elevation in ALT or AST was 29 days (range: 3 days to 11.5 months). Of the 134 patients with Grade 3 to 4 elevations in LFTs, 114 (85%) experienced complete resolution with the median time to complete resolution of 13 days (range: 4 days to 4.4 months). In Trial 1, the incidence of drug-induced liver injury (defined as concurrent elevation in ALT or AST of more than three times the upper limit of normal, alkaline phosphatase less than two times the upper limit of normal, and total bilirubin at least two times the upper limit of normal) was 1.3% (5/378). ALT or AST elevation greater than eight times the ULN occurred in 18% (67/378) of patients. Assess LFTs prior to each administration of YONDELIS^®and as clinically indicated based on underlying severity of pre‑existing hepatic impairment. Manage elevated LFTs with treatment interruption, dose reduction, or permanent discontinuation based on severity and duration of LFT abnormality.

Cardiomyopathy, including cardiac failure, congestive heart failure, ejection fraction decreased, diastolic dysfunction, or right ventricular dysfunction can occur. In Trial 1, patients with a history of New York Heart Association Class II to IV heart failure or abnormal left ventricular ejection fraction (LVEF) at baseline were ineligible. In Trial 1, cardiomyopathy occurred in 23 patients (6%) receiving YONDELIS^® and in four patients (2.3%) receiving dacarbazine. Grade 3 or 4 cardiomyopathy occurred in 15 patients (4%) receiving YONDELIS^® and 2 patients (1.2%) receiving dacarbazine; cardiomyopathy leading to death occurred in 1 patient (0.3%) receiving YONDELIS^® and in none of the patients receiving dacarbazine. The median time to development of Grade 3 or 4 cardiomyopathy in patients receiving YONDELIS^® was 5.3 months (range: 26 days to 15.3 months). Assess left ventricular ejection fraction (LVEF) by echocardiogram or multigated acquisition (MUGA) scan before initiation of YONDELIS^® and at 2- to 3-month intervals thereafter until YONDELIS^® is discontinued. Withhold YONDELIS^® for LVEF below lower limit of normal. Permanently discontinue YONDELIS^® for symptomatic cardiomyopathy or persistent left ventricular dysfunction that does not recover to lower limit of normal within 3 weeks.

Capillary Leak Syndrome (CLS) characterized by hypotension, edema, and hypoalbuminemia has been reported with YONDELIS^®, including serious CLS resulting in death. Monitor for signs and symptoms of CLS. Discontinue YONDELIS^® and promptly initiate standard management for patients with CLS, which may include a need for intensive care.

Extravasation Resulting in Tissue Necrosis — Extravasation of YONDELIS^®, resulting in tissue necrosis requiring debridement, can occur. Evidence of tissue necrosis can occur more than 1 week after the extravasation. There is no specific antidote for extravasation of YONDELIS^®. Administer YONDELIS^® through a central venous line.

Embryofetal Toxicity — Based on its mechanism of action, YONDELIS^® can cause fetal harm when administered to a pregnant woman. Advise females of reproductive potential to use effective contraception during therapy and for at least 2 months after the last dose of YONDELIS^®. Advise males with female partners of reproductive potential to use effective contraception during therapy and for at least 5 months after the last dose of YONDELIS^®.

Adverse Reactions — The most common (≥20%) adverse reactions are nausea (75%), fatigue (69%), vomiting (46%), constipation (37%), decreased appetite (37%), diarrhea (35%), peripheral edema (28%), dyspnea (25%), and headache (25%).

The most common (≥5%) grades 3-4 laboratory abnormalities are: neutropenia (43%), increased ALT (31%), thrombocytopenia (21%), anemia (19%), increased AST (17%), and increased creatine phosphokinase (6.4%).

DRUG INTERACTIONS

Effect of Cytochrome CYP3A Inhibitors — Avoid using strong CYP3A inhibitors (e.g., oral ketoconazole, itraconazole, posaconazole, voriconazole, clarithromycin, telithromycin, indinavir, lopinavir, ritonavir, boceprevir, nelfinavir, saquinavir, telaprevir, nefazodone, conivaptan) in patients taking YONDELIS^®. If a strong CYP3A inhibitor for short-term use (i.e., less than 14 days) must be used, administer the strong CYP3A inhibitor 1 week after the YONDELIS^® infusion, and discontinue it the day prior to the next YONDELIS^® infusion.

Effect of Cytochrome CYP3A Inducers — Avoid using strong CYP3A inducers (e.g., rifampin, phenobarbital, St. John's wort) in patients taking YONDELIS^®.

Please see full Prescribing Information for YONDELIS^®.

072957-170515

Advanced Soft Tissue Sarcoma Treatment Considerations

Leiomyosarcoma

Liposarcoma

Treating patients with unresectable or metastatic leiomyosarcoma or liposarcoma

Delaying disease progression is one measure of treatment success in advanced soft tissue sarcoma⁵

Consider YONDELIS^®

Indication

Important Safety Information

YOU ARE NOW LEAVING YONDELIS.COM

Advanced Soft Tissue Sarcoma Treatment Considerations

Leiomyosarcoma

Liposarcoma

Treating patients with unresectable or metastatic leiomyosarcoma or liposarcoma

Delaying disease progression is one measure of treatment success in advanced soft tissue sarcoma5

Consider YONDELIS®

YOU ARE NOW LEAVING YONDELIS.COM

Delaying disease progression is one measure of treatment success in advanced soft tissue sarcoma⁵

Consider YONDELIS^®