BACKGROUND: This meta-analysis examines the role of ifosfamide-based combination chemotherapy in patients with advanced soft tissue sarcoma. Outcomes of interest include overall survival, response rate, adverse effects, and quality of life. METHODS: A systematic review of the literature was searched to identify relevant articles. RESULTS: Three randomized phase III trials were identified comparing combination chemotherapy regimens containing ifosfamide with regimens without ifosfamide. Two randomized trials demonstrated that the addition of ifosfamide to either doxorubicin or to a regimen of doxorubicin and dacarbazine, significantly improved response rates. One randomized trial reported a significant improvement in overall survival for patients receiving doxorubicin and dacarbazine compared to those receiving a combination of doxorubicin, dacarbazine, and ifosfamide (MAID). A meta-analysis of these studies revealed that the addition of ifosfamide to a chemotherapy regimen significantly improves the tumour response rate (RR, 1.52, p=0.009) but does not produce a significant difference in 1-year survival (RR, 0.98, p=0.76). Higher rates of adverse events, particularly grades 3-4 myelosuppression, were observed in patients who received regimens that contained ifosfamide. A higher rate of toxic deaths was reported in two of the three trials, for the ifosfamide containing regimen. Data on quality of life were not reported. CONCLUSION: In patients with metastatic soft tissue sarcoma, the routine addition of ifosfamide to standard first line doxorubicin-containing regimens is not recommended over single agent doxorubicin. However, it may be reasonable to employ such combinations in patients with symptomatic, locally-advanced, or inoperable soft tissue sarcoma where response might render such tumours resectable.
BACKGROUND: This meta-analysis examines the role of ifosfamide-based combination chemotherapy in patients with advanced soft tissue sarcoma. Outcomes of interest include overall survival, response rate, adverse effects, and quality of life. METHODS: A systematic review of the literature was searched to identify relevant articles. RESULTS: Three randomized phase III trials were identified comparing combination chemotherapy regimens containing ifosfamide with regimens without ifosfamide. Two randomized trials demonstrated that the addition of ifosfamide to either doxorubicin or to a regimen of doxorubicin and dacarbazine, significantly improved response rates. One randomized trial reported a significant improvement in overall survival for patients receiving doxorubicin and dacarbazine compared to those receiving a combination of doxorubicin, dacarbazine, and ifosfamide (MAID). A meta-analysis of these studies revealed that the addition of ifosfamide to a chemotherapy regimen significantly improves the tumour response rate (RR, 1.52, p=0.009) but does not produce a significant difference in 1-year survival (RR, 0.98, p=0.76). Higher rates of adverse events, particularly grades 3-4 myelosuppression, were observed in patients who received regimens that contained ifosfamide. A higher rate of toxic deaths was reported in two of the three trials, for the ifosfamide containing regimen. Data on quality of life were not reported. CONCLUSION: In patients with metastatic soft tissue sarcoma, the routine addition of ifosfamide to standard first line doxorubicin-containing regimens is not recommended over single agent doxorubicin. However, it may be reasonable to employ such combinations in patients with symptomatic, locally-advanced, or inoperable soft tissue sarcoma where response might render such tumours resectable.
Authors: M Ballesteros; N Montero; A López-Pousa; G Urrútia; I Solà; G Rada; H Pardo-Hernandez; X Bonfill Journal: Clin Transl Oncol Date: 2019-03-14 Impact factor: 3.405
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Authors: Anna Minchom; Robin L Jones; Cyril Fisher; Omar Al-Muderis; Sue Ashley; Michelle Scurr; Vasilios Karavasilis; Ian R Judson Journal: Sarcoma Date: 2010-05-20
Authors: Mustafa Abugideiri; James Janopaul-Naylor; Jeffrey Switchenko; Sibo Tian; William Read; Robert Press; Shervin Oskouei; Nickolas Reimer; Matthew Ferris; Richard J Cassidy; Madhusmita Behera; David Monson; Jerome Landry; Karen D Godette; Pretesh R Patel Journal: Ann Surg Oncol Date: 2021-07-16 Impact factor: 5.344