Sylvie Bonvalot, MD, PhD, Discusses Selecting Patients With Locally Advanced Sarcoma for Pre and Postoperative Treatment

At the 2021 American Society of Clinical Oncology (ASCO) Annual Meeting, CancerNetwork® spoke with Sylvie Bonvalot, MD, PhD, from Institut Curie, about standard of care and treatment options for patients with high-grade or grade II sarcoma.

Bonvalot discusses a phase 2/3 trial (NCT02379845) that used the radioenhancer NBTXR3 as a preoperative treatment to radiotherapy for high-grade sarcoma. The findings of this study were positive and reinforced the use of NBTXR3 in patients with locally advanced soft tissue sarcoma.1 In her discussion, she talks about leaning on colleagues across multidisciplinary oncology teams to select patients who are appropriate for treatment.

Transcript:

In locally advanced sarcoma of at least high-grade or grade 2 [disease], the standard treatment is surgery and radiotherapy and more and more of this [is by] local treatment. Radiotherapy is delivered preoperatively because the long-term morbidity is lower than postoperative therapy. There was a trial run by O’Sullivan a few years ago and clearly preoperative radiotherapy had a better outcome in the long term; [however] you cannot do that for everyone.2

When there was indication and sufficient fit for appropriate radiotherapy, we do more of the radiotherapy postoperatively. This is for high-grade locally advanced sarcoma. Concerning chemotherapy, it’s not standard of care. They would debate, it depends on the subtype, but neoadjuvant chemotherapy is still an option in the guidelines; it’s not always the patient. Usually for grade II or III locally advanced sarcoma, standard of care is a radiotherapy and surgery and the option is a chemotherapy for a subgroup of patients with specific subtype, [such as a] young patient because classically it is a little bit difficult for elderly patients. It’s not the standard of care to deliver the chemotherapy for outpatient surgeries and why the standard is radiotherapy and surgery. In this trial we did, we’re discussing [patients] in the multi-disciplinary tumor board. When it was a locally advanced high-grade sarcoma, the conclusion was radiotherapy and surgery, and the trial was proposed to the patient.

References

1. Bonvalot S, Rutkowski P, Thariat J, et al. Long-term evaluation of the novel radioenhancer NBTXR3 plus radiotherapy in patients with locally advanced soft tissue sarcoma treated in the phase II/II Act.In.Sarc trial. . J Clin Oncol. 2021; 39(suppl 15):11544. 10.1200/JCO.2021.39.15_suppl.11544

2. O’Sullivan B, Davis AM, Turcotte R, et al. Preoperative versus postoperative radiotherapy in soft-tissue sarcoma of the limbs: a randomised trial. Lancet. 2002;359(9325):2235-2241. doi:10.1016/S0140-6736(02)09292-9