High-dose chemotherapy with autologous hematopoietic stem-cell transplantation for advanced soft tissue sarcoma in adults

Purpose: Patients with metastatic or locally advanced, unresectable soft tissue sarcoma (ASTS) are seldom curable, with 5-year survival rates of less than 10% in all large series. The role of high-dose chemotherapy (HDCT) with hematapoietic stem-cell support in this disease is not established. Patients and Methods: Between 1988 and 1994,30 patients with ASTS who responded to a standard chemotherapy regimen were included in a prospective pilot study of HDCT as consolidation therapy using ifosfamide (12 g/m(2)), etoposide (800 mg/m(2)), and cisplatin (200 mg/m(2)) (VIC). Results: The median duration of grade 4 neutropenia and thrombocytopenia was 14 and 10 days, respectively. Nineteen patients (63%) experienced grade 1 or higher renal toxicity, All eight patients in complete remission (CR) before HDCT were still in CR at day 60. Of the 22 patients in partial remission (PR) or with a minor response to conventional chemotherapy, CR, PR, and stable disease were achieved in four (18%), three (13%), and 12 patients (54%), respectively, by day 40, while three patients (14%) progressed. With a median follow-up of 94 months, overall and pragression-free survival rates at 5 years after HDCT were 23% and 21%, respectively. Patients in CR before HDCT had ct significantly superior 5-year overall survival rate compared with other patients (75% v 5%; P = .001), Conclusion: Despite the toxicity of the VIC regimen, a high survival rate was observed in HDCT-treated patients who were in CR after conventional chemotherapy, A phase III randomized trial is required to establish the role of HDCT in ASTS. (C) 2000 by American Society of Clinical Oncology.