Chemotherapy of advanced soft-tissue sarcomas.

The most active single agents in soft-tissue sarcomas are doxorubicin (Adriamycin) and ifosfamide, with response rates of 20-35%. Dacarbazine (DTIC) has a response rate of 16%. A randomized trial of 5 g/m2 of ifosfamide versus 1.5 g/m2 of cyclophosphamide noted a higher response rate for ifosfamide with less myelosuppression. Both randomized studies of doxorubicin with or without DTIC documented an increased response rate for the combination. In contrast, three randomized trials of doxorubicin-based regimens with and without cyclophosphamide have failed to detect an advantage for the addition of cyclophosphamide. Thus, the most active combination for soft-tissue sarcomas is doxorubicin and DTIC. The role of the addition of ifosfamide is currently under evaluation.