title: Trabectedin clinical cases: use according to indication in diverse clinical scenarios.
abstract: BACKGROUND
  Key distinguishing characteristics of trabectedin in the treatment of advanced soft tissue sarcoma are its prolonged tumor control activity in multiple histological subtypes, positive outcomes in translocation-related sarcomas, maintenance of response, option to rechallenge after treatment interruption and lack of cumulative toxicity. Trabectedin is indicated for use in advanced soft tissue sarcoma after failure of anthracyclines and ifosfamide, or as front-line treatment in patients unsuited to receive these agents.
  
  
  METHODS
  In this review, cases studies are presented in which trabectedin was used according to its indication but in diverse clinical settings.
  
  
  RESULTS
  As second-line treatment of uterine leiomyosarcoma, trabectedin produced prolonged tumor control with good quality of life. In treatment of recurrent synovial sarcoma, the best objective response (partial response) and longest disease control (37 months) was achieved under treatment with trabectedin. As neoadjuvant treatment of undifferentiated pleomorphic sarcoma in a patient unsuited to receive doxorubicin-based chemotherapy, trabectedin induced a pathological response with 85% of necrosis.
  
  
  CONCLUSIONS
  These cases illustrate the broad range of indications for trabectedin in advanced soft tissue sarcoma and highlight how its unique characteristics can be optimized to achieve maximum clinical benefit.
authors.affiliation: 1Medical Oncology Unit, Candiolo Cancer Institute - FPO, IRCCS, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Grignani
authors.affiliation: 2MUsculoSkeletal Tumor Board of Excellence Sevilla (MUSTBE SEVILLA), Virgen del Rocío University Hospital, Sevilla, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Martín-Broto
authors.affiliation: 3Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden University of Technology, Dresden, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Schuler
authors.affiliation: 4Department of Interdisciplinary Oncology, HELIOS Klinikum Berlin-Buch, Berlin, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Reichardt
mesh_terms: D018943:Anthracyclines / Q000008:administration & dosage; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003131:Combined Modality Therapy; D000075202:Contraindications; D003606:Dacarbazine / Q000008:administration & dosage; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004149:Dioxoles / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005266:Femoral Neoplasms / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007044:Hysterectomy; D007069:Ifosfamide / Q000008:administration & dosage; D007890:Leiomyosarcoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D011877:Radionuclide Imaging; D012074:Remission Induction; D016879:Salvage Therapy; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D013584:Sarcoma, Synovial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000532:radiotherapy / Q000556:secondary; D012983:Soft Tissue Neoplasms / Q000188:drug therapy* / Q000473:pathology; D044005:Tetrahydroisoquinolines / Q000008:administration & dosage / Q000627:therapeutic use*; D013848:Thigh; D014057:Tomography, X-Ray Computed; D000077606:Trabectedin; D016896:Treatment Outcome; D014594:Uterine Neoplasms / Q000188:drug therapy / Q000601:surgery; D000093542:Gemcitabine
chemical_list: D018943:Anthracyclines; D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D044005:Tetrahydroisoquinolines; D003841:Deoxycytidine; D003606:Dacarbazine; D000077606:Trabectedin; D007069:Ifosfamide; D000093542:Gemcitabine
keywords: clinical case studies; dosing guidelines; neoadjuvant chemotherapy; synovial sarcoma; trabectedin rechallenge; undifferentiated pleomorphic sarcoma; uterine leiomyosarcoma