a rare neoplasm, still very difficult to cure, typical of adolescents and young adults. A large international study now indicates to specialists the way forward in the choice of therapeutic strategy, on a case-by-case basis
Ewing’s sarcoma is a rare tumor that affects mainly adolescents and young adults and affects the bones or soft tissues of the body. Despite the many advances it remains difficult to fight because it often does not respond or resist the available therapies. The researchers of the Euro-Ewing European Consortium took a step forward who, during the plenary session of the annual congress ofAmerican society of clinical oncology (Asco) underway in Chicago, presented the data of a study that reached important conclusions: they have, in fact, succeeded in compare the four different chemotherapy schemes used today and understand which one is bestweighing not only the antitumor potency but also the toxicity.
A comparison that evaluates efficacy and side effects
Ewing’s sarcoma is treated with the combination of chemotherapy, surgery and radiation therapy, he explains Roberto Luksch, pediatrician oncologist of the IRCCS National Cancer Institute of Milan, one of the authors of the research -. About 30% of patients who have a localized disease at the onset and over 50% of those who already have metastases at the beginning end up not responding to therapies (those who define themselves as “refractory”) or to experience a relapse after first-line therapy. Unfortunately, these situations affect the prognosis in an unfavorable way. Before this experimentation, despite having available several potentially active therapy schemes against sarcoma even in these conditions, we lacked robust scientific evidence on the basis of which choose the best therapeutic regimen in terms of risks and benefits.
For this reason, the Euro-Ewing European Consortium, which also includes several national centers of the Italian sarcoma group (Isg) and the Italian Association of Pediatric Hematology and Oncology (Aieop), has designed the first randomized study in which they are compared the best commonly used schemes, whose efficacy and side effects are compared.
The best chemotherapy regimen
There are about 75 young people in Italy every year who receive the diagnosis of Ewing’s sarcoma e the five-year survival rate from the discovery of the disease is around 50%. The prognosis depends on many factors (such as tumor size, location of the disease, stage and timeliness of diagnosis) and the rarity of the disease complicates the work of specialists who try to develop new therapies or to make the most of them. available. indeed important to be able to collect information on large numbers of cases in order to reach scientifically valid and reliable conclusions and here lies the great value of the study presented to Asco in plenary session, the one reserved for the most important progress.
The trial, which between 2014 and 2021 enrolled 451 European patients on average 19 years old (aged between 4 and 49 years), compared four different chemotherapy regimens – explains Luksch -: gemcitabine + taxotere (GT), irinotecan + temozolomide (TEMIRI), high-dose ifosfamide (HDIFO) and topotecan + cyclophosphamide (Topo / Cyclo). We now know that HDIFO gave the best results in terms of response duration and survival, albeit slightly above Topo / Cyclo. Indeed, with the use of high-dose ifosfamide there is an advantage in terms of progression-free survival of a few months (it reaches on average almost six) and the average survival reaches over 16 months.
New treatments are being studied
Of course, much work remains to be done to increase the recovery rates, but scientific research continues in small steps (promising results of an Italian research were also announced at Asco 2020). International cooperation has made it possible to finalize a study with a large number of patients and in a reasonable time despite the rarity of the disease – underlines the expert -. The strength of this international academic reality makes it possible to attracting interest and investment from pharmaceutical industries for the development of new drugs and in the context of this randomized study we foresee the opening of a new treatment arm with or without the association of a target therapy with the standard reference chemotherapy.
What changes for patients under treatment today
Now, based on this study, high-dose ifosfamide is the reference therapy with which the new comparison trials will continue. What changes for those diagnosed with Ewing’s sarcoma today? The results of the study, still in progress, do not condition a change in the treatment strategy for Ewing’s sarcoma, but have given a scientifically proven and robust indication on what are the probabilities of response to second line therapies and will allow use HDIFO as a reference standard to study its effects in combination with new drugs in the setting of patients with refractory or relapsing disease – concludes Luksch -. Furthermore, since the other regimes studied have also proved to be active, the availability of precise data on toxicity and quality of life with the different regimens they will allow to choose the most suitable therapy scheme for each individual patient in case HDIFO is excessively “heavy” to tolerate.
June 5, 2022 (change June 5, 2022 | 14:00)
© Time.News