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 ti ssue 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) wit h hematapoietic stem-cell support in this disease is not established. Patients and Methods: Between 1988 and 1994,30 patients with ASTS who respo nded to a standard chemotherapy regimen were included in a prospective pilo t study of HDCT as consolidation therapy using ifosfamide (12 g/m(2)), etop oside (800 mg/m(2)), and cisplatin (200 mg/m(2)) (VIC). Results: The median duration of grade 4 neutropenia and thrombocytopenia wa s 14 and 10 days, respectively. Nineteen patients (63%) experienced grade 1 or higher renal toxicity, All eight patients in complete remission (CR) be fore HDCT were still in CR at day 60. Of the 22 patients in partial remissi on (PR) or with a minor response to conventional chemotherapy, CR, PR, and stable disease were achieved in four (18%), three (13%), and 12 patients (5 4%), 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 befor e 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 w as observed in HDCT-treated patients who were in CR after conventional chem otherapy, A phase III randomized trial is required to establish the role of HDCT in ASTS. (C) 2000 by American Society of Clinical Oncology.