Neeta Somaiah, MD, is a professor and department chair of the Department of Sarcoma Medical Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center. 

Neeta Somaiah, MD, details challenges that are associated with pathology diagnosis, NGS, and early opinions for patients with sarcomas. 

Dr Somaiah on Overcoming Challenges to Multidisciplinary Approaches in Sarcoma

“I think the biggest challenge that still remains is the rarity of [sarcoma]; with the rarity comes the pathology diagnosis of the subtypes, so I think the big push [in sarcoma] is making sure patients get an early opinion at an expert center.”

Neeta Somaiah, MD, a professor and department chair of the Department of Sarcoma Medical Oncology in the Division of Cancer Medicine at The University of Texas MD Anderson Cancer Center, detailed challenges associated with pathology diagnosis and next-generation sequencing (NGS) in the sarcoma landscape.

A significant challenge in the sarcoma setting is the rarity of the disease type, along with the need for a careful pathology review regarding sarcoma subtypes, Somaiah began. She noted that there’s a big push for patients to get early opinions at expert centers that can provide a proper review of the pathology. However, she emphasized that when the pathology gets sent off to NGS—although essential and a more common practice—it also needs to be matched with the pathology diagnosis. This step is important because it could reveal nuances of sarcomas based on where they arise in the body and where they could potentially metastasize, she explained. Additionally, Somaiah noted that matching NGS results with the pathology could also help determine if patients require early systemic therapy and identify those who could delay these therapies. Therefore, treating sarcomas requires a multidisciplinary approach, she emphasized.

Furthermore, Somaiah explained that it can be a challenge to get patients to an academic center with experienced treating patients with different subtypes of sarcomas often and understands the nuances of sarcomas, as well as each subtype, so patients can receive an accurate diagnosis. Nevertheless, great progress can be made if correct treatment is instituted early; therefore, having patients get early opinions can significantly help guide care for patients with sarcomas, she concluded.

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Neeta Somaiah, MD, discusses chemotherapy as the current mainstay of treatment in sarcoma subtypes and the emergence of immunotherapies in the space.

Dr Somaiah on the Role of Chemotherapy in Sarcomas

“We still use chemotherapy to begin with [in treating patients with sarcomas], but there are a lot of targeted therapy options and clinical trials that we think of. For some of the disease subtypes, targeted therapies have replaced chemotherapy, which is quite exciting.”

Neeta Somaiah, MD, professor, department chair, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the role of chemotherapy in the management of sarcomas.

In the realm of sarcomas, chemotherapy is still considered the mainstay of treatment, especially in patients with metastatic or locally advanced disease, Somaiah begins. In the past 5 years, the list of chemotherapy options and regimens has been smaller, she explains. However, she notes that there has been a growing list of immunotherapies and targeted therapies, which continues to expand.

Now, subtypes of sarcomas and more biomarkers are being better established, Somaiah says. Having these identified helps determine optimal treatment options, particularly for rarer subtypes of sarcoma, she adds.

 to afamitresgene autoleucel (afami-cel; Tecelra) for the treatment of patients with unresectable or metastatic synovial sarcoma. Subsequently, in September 2024, the FDA 

approved atezolizumab and hyaluronidase-tqjs

 (Tecentriq Hybreza) for subcutaneous injection for the use of all of the existing adult indications as the intravenous formulation of atezolizumab (Tecentriq), which included alveolar soft part sarcoma, among other solid tumors. Atezolizumab was 

 in December 2022 for the treatment of adult and pediatric patients at least 2 years of age with alveolar soft part sarcoma.

Therefore, the shift from chemotherapy-only regimens to immunotherapies has been seen in select sarcoma subtypes, Somaiah notes. Chemotherapy is typically where treatment starts; nonetheless, more clinical trials and approved immunotherapies are starting to replace the use of chemotherapy, which is exciting, she concludes.

Neeta Somaiah, MD, discusses ongoing research with novel agents that have emerged and those that could soon emerge in the sarcoma treatment paradigm.

Dr Somaiah on Ongoing Research With Novel Agents in Sarcomas

“[In 2024,] the first T-cell therapy was approved [for advanced synovial sarcoma]. I think that field is still nascent, and we’re going to see a lot of work in that field moving forward because there are more cellular therapies that are going to come forward in that area.”

Neeta Somaiah, MD, professor, department chair, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses ongoing research with novel agents that may potentially alter the sarcoma treatment paradigm.

Although chemotherapy remains highly prevalent in the sarcoma treatment paradigm, more targeted therapies have emerged and are being developed, specifically for desmoid sarcomas, Somaiah begins, highlighting ongoing work with gamma-secretase inhibitors. A phase 3 trial (NCT03785964) evaluated the gamma-secretase inhibitor nirogacestat for the treatment of desmoid sarcoma, in which patients were randomly assigned to be treated with either nirogacestat (n = 70) or placebo (n = 72). Data demonstrated that patients treated with nirogacestat experienced a significant progression-free survival benefit compared with placebo (HR, 0.29; 95% CI, 0.15-0.55; 

 < .001). Of note, the likelihood of being event-free at 2 years was 76% vs 44% in the nirogacestat and placebo arms, respectively.

FDA granted accelerated approval to afamitresgene autoleucel

 (afami-cel; Tecelra) for the treatment of patients with unresectable or metastatic synovial sarcoma, which was the first T-cell therapy approved for sarcoma, Somaiah says. The FDA’s decision was supported by data from cohort 1 of the phase 2 SPEARHEAD-1 trial (NCT04044768). Among patients treated with afami-cel (n = 44), the overall response rate was 43% per independent review assessment; the complete response rate was 4.5%. The median duration of response (DOR) was 6 months (95% CI, 4.6–not reached), and the 12-month DOR rate was 39%. Somaiah concludes that although the treatment landscape for sarcomas is still developing, new therapies are on the horizon, notably for patients within specific sarcoma subtypes.

Neeta Somaiah, MD, discusses ongoing research with novel agents that have emerged and those that could soon emerge in the sarcoma treatment paradigm. 

Neeta Somaiah, MD, associate professor, deputy department chair, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses enrollment criteria for the phase 3 Peak trial (NCT05208047) in patients with gastrointestinal stromal tumor (GIST) and the advantages of this trial’s design.

The Peak trial is investigating bezuclastinib (CGT9486) in combination with sunitinib (Sutent) vs sunitinib alone in patients with GIST. The first portion of part 1 of this trial enrolled patients who had received at least 1 prior line of therapy for GIST. The second evaluation of part 1 enrolled patients who had received at least 2 prior TKIs for GIST. Part 2 of this trial is enrolling patients who progressed on or are intolerant to imatinib.

Many patients with GIST receive imatinib (Gleevec) in the first line and may switch to local treatment options upon local progression, Somaiah says. Patients who progress with more diffuse disease may be eligible for enrollment in the Peak trial, Somaiah notes. GIST is a relatively easier-to-treat sarcoma because it has standard first-, second-, third-, and fourth-line therapeutic options, which patients may be referred to upon progression on imatinib, according to Somaiah. However, community oncologists should consider the Peak trial before prescribing standard lines of therapy beyond imatinib. Patients with GIST who receive treatment beyond imatinib are not eligible for enrollment in Peak and lose the chance to receive an additional line of targeted therapy, Somaiah emphasizes.

Data from part 1 of Peak, which were presented at the 2023 ASCO Annual Meeting, showed that bezuclastinib plus sunitinib was well tolerated, Somaiah notes. The safety profile of this combination supports further enrollment in this trial, Somaiah says.

Additionally, even patients in the Peak trial who are not randomly assigned to receive the investigative combination will receive sunitinib monotherapy in the control arm, Somaiah explains. This trial is distinct from placebo-controlled trials because it offers patients standard benefits in both arms, Somaiah emphasizes. Furthermore, patients who are randomly assigned to receive sunitinib monotherapy may have the option of crossing over to the investigative arm upon disease progression, Somaiah notes. Raising awareness about the advantages of this second-line trial can help more patients access a potentially beneficial treatment combination, Somaiah concludes.

Neeta Somaiah, MD, discusses enrollment criteria for the phase 3 Peak trial in patients with gastrointestinal stromal tumor and the advantages of this trial’s design.

Dr Somaiah on the Peak Trial in GIST

Neeta Somaiah, MD, associate professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses ​remaining challenges in soft tissue sarcoma.

Due to the number of ​sarcoma subtypes, defining ​the optimal treatment for patients with soft tissue sarcoma remains an ongoing challenge, says Somaiah.

Additionally, other factors such as the degree of responsiveness and the likelihood of recurrence could also inform treatment selection​, Somaiah explains. Notably, many institutions have their own approach to adjuvant therapy.

In recent years, significant advances have been made in the advanced/metastatic setting; however, there is still room for improvement. Future research should include more subtype​-specific trials ​to better define which patient populations should receive targeted therapy, Somaiah concludes.

Neeta Somaiah, MD, discusses ​remaining challenges in soft tissue sarcoma.

 Dr. Somaiah on Remaining Challenges in Soft Tissue Sarcoma  

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the next steps following the phase I findings of the CMB305 trial in patients with NY-ESO-1–positive recurrent soft tissue sarcoma. 

The initial next step is to determine the patient population who will benefit the most from this regimen, explains Somaiah. 

This drug can be compared against other regimens in the maintenance or third-line setting in order to determine if CMB305 will help a patient delay progression, states Somaiah. 

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the next steps following the phase I findings of the CMB305 trial in patients with NY-ESO-1–positive recurrent soft tissue sarcoma.

Dr. Somaiah on Next Steps for CMB305 in Soft Tissue Sarcoma

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the expression of NY-ESO-1 in patients with soft tissue sarcoma.

There were previous studies looking at the NY-ESO-1 expression across different sarcoma subtypes, explains Somaiah. However, the percentage of NY-ESO-1 expression in those other subtypes is around 30% whereas it is around 80% to 100% for soft tissue sarcoma.

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses the expression of NY-ESO-1 in patients with soft tissue sarcoma.


Dr. Somaiah on NY-ESO-1 Expression in Soft Tissue Sarcoma

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses phase I findings of CMB305 in patients with NY-ESO-1—positive recurrent soft tissue sarcoma.

CMB305 is a prime boost immunotherapy that targets the NY-ESO-1 antigen, Somaiah explains. It consists of a dendritic cell targeting that is co-administered with G305, which is a potent agonist given with the entire NY-ESO-1 protein. This leads to robust immune response with both T cells and antibodies.

This is a phase I dose-escalation study with a dose-expansion cohort. Of the total 49 patients included in the safety population, 25 had sarcoma—the majority of which had synovial sarcoma or myxoid liposarcoma. The results of this study included patients who had relapsed metastatic sarcoma with a limited tumor burden.

It was found that the median overall survival (OS) of these 25 patients had not yet been reached. Eighty-three percent of patients were still alive at 1 year; the 12-month OS rate was 83%, and 76% of patients are still alive at 19 months.

Neeta Somaiah, MD, assistant professor, Department of Sarcoma Medical Oncology, Division of Cancer Medicine, The University of Texas MD Anderson Cancer Center, discusses phase I findings of CMB305 in patients with NY-ESO-1–positive recurrent soft tissue sarcoma.

Neeta Somaiah, MD

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