Cedars-Sinai Medical Center, Los Angeles, CA
Andrew Eugene Hendifar , Neal S Chawla , Kamalesh Kumar Sankhala , Xiao Zhang , Doris V. Quon , Victoria S Chua , Lita Fernandez , William E. Mendanha , Sant P. Chawla
Background: Gemcitabine and docetaxel chemotherapy protocols have proven efficacy in the treatment of metastatic soft tissue sarcomas. Doxorubicin is also a commonly used treatment both as a single agent and as a part of combination therapies. This phase 2 study was designed to assess the efficacy and safety of a combination regimen of gemcitabine, docetaxel , and doxorubicin. Methods: This is a single institution study of advanced sarcoma pateints who were refractory to 1st line chemotherapy. Adequate performance status, organ function, and measurable disease (RECIST v1.1) were required. Patients received Gemcitabine (400 mg/m2), Doxorubicin (20 mg/m2) and Docetaxel (20 mg/m2) on days 1 and 8 of a 21 day cycle, and must have completed 2 cycles in order to be evaluable. Disease assessment was completed using the RECIST 1.1 criteria and toxicity was evaluated using the NCI CTCAE version 4.2. Results: A total of 32 patients were enrolled from 08/2011 - 08/2014 and 31 patients received at least 2 cycles of therapy. Pts with leiomyosarcoma (n = 7) liposarcoma (7) synovial sarcoma (2), chondrosarcoma (2), bone tumors (6), and others (8). The majority of patients (n = 21, 66%) previously received doxorubicin and many (n = 8, 25%) had previously received gemcitabine and docetaxel in combination. The average number of previous regimens was 3 previous chemotherapies (range, 1 to 7). The median age was 49 (range, 21 – 69). A median of 5 cycles of gemcitabine, docetaxel and doxorubicin were given (range, 1-12). A partial response was seen in 16 % of patients (5/31), and stable disease > 3 months in 39% (12/31). Clinical benefit (CR+PR+SD > 3months) was 17/31 55% (95% CI .36 -0.7) Grade 3 and 4 hematologic toxicities were observed in 14 patients (thrombocytopenia 12 pts, and neutropenia 2 pts) however, no patients were discontinued for toxicity. Conclusions: The combination of gemcitabine, doxorubicin, and docetaxel is an active regimen with a manageable toxicity profile in patients with advanced and pre-treated soft tissue and bone sarcomas.
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