Chemotherapy for soft tissue sarcoma
Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. It is sometimes used to treat certain types of soft tissue sarcoma. The benefits of chemotherapy for soft tissue sarcoma are unclear because different studies have shown different results. For this reason, your healthcare team will use their expertise in treating soft tissue sarcoma and will consider your specific case when deciding to offer you chemotherapy.
When chemotherapy is used
Chemotherapy may be given, with or without radiation therapy, before surgery. Giving chemotherapy before surgery is called neoadjuvant, or preoperative, chemotherapy. This approach may help to make the tumour easier to remove. It is sometimes used for tumours that are larger than 5 cm, that have grown into nearby structures or that can’t be surgically removed (are inoperable). You may also be offered chemotherapy if you have a subtype of sarcoma that responds well to chemotherapy and the healthcare team thinks that chemotherapy may downstage the tumour before surgery. The healthcare team will also consider using chemotherapy before surgery if the cancer has spread, or metastasized, to other parts of the body.
Chemotherapy may be given after surgery, which is called adjuvant chemotherapy. The goal of adjuvant chemotherapy is to destroy cancer cells left behind after surgery and to reduce the risk that cancer will come back, or recur. It is used for high-grade, deep or large tumours or tumours in a limb or other site if the cancer is likely to recur.
Chemotherapy may be given to relieve pain or control symptoms of advanced soft tissue sarcoma. This is called palliative chemotherapy. Palliative chemotherapy can be helpful if soft tissue sarcoma has spread, or metastasized, and is causing symptoms or progressing rapidly. It can also help control symptoms of a tumour that can’t be removed by surgery (is inoperable).
How chemotherapy is given
Chemotherapy is usually a systemic therapy. This means that the drugs travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour. Chemotherapy may also be a regional therapy, which means that it is given to specific areas of the body.
Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. It is usually given intravenously on an outpatient basis. The treatment is usually given every 3–4 weeks over a period of 6–12 months, depending on the type of soft tissue sarcoma and the treatment plan.
Chemotherapy drugs commonly used for soft tissue sarcoma
The most common chemotherapy drugs used to treat soft tissue sarcoma are:
- doxorubicin (Adriamycin)
- ifosfamide (Ifex)
- epirubicin (Pharmorubicin)
- gemcitabine (Gemzar)
- dacarbazine (DTIC)
- liposomal doxorubicin
- temozolomide (Temodal)
- vinorelbine (Navelbine)
- cisplatin (Platinol AQ)
- docetaxel (Taxotere)
- cyclophosphamide (Cytoxan, Procytox)
- pazopanib (Votrient)
The most common chemotherapy combinations used to treat soft tissue sarcoma are:
- doxorubicin and dacarbazine
- doxorubicin, ifosfamide and mesna (Uromitexan)
- doxorubicin, ifosfamide, dacarbazine and mesna
- ifosfamide, epirubicin and mesna
- ifosfamide, etoposide (Vepesid, VP-16) and mesna
- gemcitabine and docetaxel
- gemcitabine and vinorelbine
- gemcitabine and dacarbazine
- vincristine (Oncovin), dactinomycin (Cosmegen, actinomycin-D) and cyclophosphamide
Mesna is not a chemotherapy drug. It is a drug given to protect the bladder from the toxic effects of ifosfamide.
Chemotherapy for specific types of soft tissue sarcoma
Some types of soft tissue sarcoma are treated with certain chemotherapy drugs or combinations.
Chemotherapy drugs given alone to treat adult rhabdomyosarcoma are:
- irinotecan (Camptosar)
- topotecan (Hycamtin)
Chemotherapy combinations used to treat adult rhabdomyosarcoma are:
- vincristine, dactinomycin and cyclophosphamide
- vincristine, doxorubicin and cyclophosphamide
- vincristine, doxorubicin and cyclophosphamide alternated with ifosfamide and etoposide (Vepesid, VP-16)
- vincristine, doxorubicin and ifosfamide
- cyclophosphamide and topotecan (Hycamtin)
- ifosfamide and doxorubicin
- ifosfamide and etoposide
- irinotecan (Camptosar, CPT-11) and vincristine
- carboplatin (Paraplatin) and etoposide
- vinorelbine and cyclophosphamide
- vincristine, irinotecan and temozolomide
The most common chemotherapy drugs used to treat angiosarcoma are:
- paclitaxel (Taxol)
- sorafenib (Nexavar)
- sunitinib (Sutent)
- bevacizumab (Avastin)
The most common chemotherapy drugs used to treat hemangiopericytoma are:
- bevacizumab and temozolomide
Alveolar soft tissue sarcoma
The most common chemotherapy drug used to treat alveolar soft tissue sarcoma is sunitinib.
The most common chemotherapy drugs used to treat PEComa are:
- sirolimus (Rapamune)
- everolimus (Afinitor)
Information about specific cancer drugs
Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.
Questions to ask about chemotherapy
Cancer affects all Canadians
Nearly 1 in 2 Canadians is expected to be diagnosed with cancer in their lifetime.