Moving the Needle in Undifferentiated Pleomorphic Sarcoma: Multidisciplinary Collaboration

In this episode of OncChats: Moving the Needle in Undifferentiated Pleomorphic Sarcoma, the following experts discuss the landmark Stand Up to Cancer SARC 032 study (NCT03092323), highlighting the importance of multidisciplinary collaboration, the significant improvement in disease-free survival with relatively low toxicity, and the potential for expanding this treatment approach to other sarcomas.

Femino: Dr Agulnik, this has really been a landmark study for the treatment of undifferentiated pleomorphic sarcoma. Why is it exciting?

Agulnik: It is exciting on so many levels. It would be lost if we didn’t acknowledge how fortunate we are that we work with each other. Because I think we’re somewhat spoiled. As sarcoma specialists, it is amazing that we get to partner, learn from, and collaborate with peers in each discipline, between orthopedic, surgical, and radiation oncology. We have pathology, we have radiology, we have expertise across our nurse practitioners, our PAs, and pharmacy, to really help us manage these patients. I think what this study shows is that you really need that multidisciplinary care. For patients to come through centers that don’t have multidisciplinary care, they potentially can be compromising their care, as highlighted in this study. So, I think it is groundbreaking that you have a study that gets buy in and support, as well as groups that came together—including orthopedic, surgical, radiation, and medical oncology—to collaborate, come up with a concept, and get this concept sent out to the world.

This [study] was done across multiple countries throughout the world. It was also done in its landmark [population]; it was done from patients aged 12 [years] and above and so there is a safety [in knowing that] in this adolescent/young adult population, this somewhat pediatric population, that we could use this to make a substantial difference. What’s most exciting is that it is a substantial difference for our patients. The absolute benefit of disease-free survival [DFS] was about 15%, which is substantial. To move the marker that much with a drug therapy that is relatively nontoxic compared with other therapies we have [is substantial]. We’ve all seen patients who have been treated with adriamycin or doxorubicin, with ifosfamide, or with other therapies that we traditionally use for our [patients with] sarcoma, and we’ve seen here that patients tolerate this therapy better as a whole.

That is certainly very encouraging. To bring something into a setting that is not metastatic, to bring something into a setting where we all collaborate together, where we’ve all made a difference together, is very substantial. It’s very fortunate for us in this community to be able to show that we could collaborate together [to make an] impact and [underscore the] meaning of multidisciplinary care [with regard to] the management of our patients. The patients win in the end because they have improved DFS and their distant disease free[–survival] is also improved with this.

As we follow this study longitudinally, which we will, and it will get presented at other meetings in the future, I anticipate that overall survival will be impacted, as well. We’ll see that ripple effect of this study and hopefully, this will not only be a UPS thing. Hopefully, the study could get replicated, and perhaps [we’ll find] there is a role for this treatment in other types of sarcomas, as well.