title: Complete response after rechallenge with trabectedin in a patient with previously responding high-grade undifferentiated sarcoma.
abstract: Evidence supporting rechallenge in patients responding to first exposure to trabectedin is limited. We report on a 39-year-old woman with advanced high-grade undifferentiated sarcoma (US) retreated twice with trabectedin after first response. The patient presented in June 2006 with an abdominal mass originating from the rear fascia of the rectus abdominis. Staging examinations did not indicate metastases and she underwent surgery; pathology showed a high-grade (FNCLCC G3) US. Subsequently, the patient received five cycles of adjuvant chemotherapy with epirubicin and ifosfamide. In February 2009 a computed tomography (CT) scan showed an abdominal mass involving the transverse mesocolon. R0 surgery was performed. In September 2009, peritoneal lesions appeared. Trabectedin was initiated at a dose of 1.5 mg/m by a 24 h intravenous infusion every 3 weeks, without relevant toxicity. After six cycles (March 2010), CT and PET-CT scans showed complete disappearance of metastases. In February 2012, new secondary lesions in the subdiaphragmatic region and a peritoneal lesion appeared. We rechallenged the patient with the same schedule of trabectedin; a complete response was achieved after two cycles. In October 2013, new secondary lesions in the subdiaphragmatic region and a retroperitoneal lesion were found. We rechallenged with the same schedule of trabectedin; PET-CT scans after two cycles showed complete response on the subdiaphragmatic lesion. Radiotherapy on the retroperitoneal lesion was performed. The patient underwent a total of 18 cycles and remains free from radiologically detectable disease. We report complete radiological remission after two rechallenges with trabectedin in a patient with previously responding high-grade US.
authors.affiliation: a'Sandro Pitigliani' Medical Oncology Unit bRadiology Unit cNuclear Medicine Unit, Hospital of Prato, Prato dSarcoma Unit, Department of Cancer Medicine, Istituto Nazionale Tumori, Milan eRadiotherapy Unit fNuclear Medicine Unit, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST-IRCCS), Meldola gAnatomic Pathology Unit, General Hospital of Treviso, Treviso, Italy.
authors.forename: Giacomo G
authors.initials: GG
authors.lastname: Baldi
authors.forename: Samantha
authors.initials: S
authors.lastname: Di Donato
authors.forename: Rossana
authors.initials: R
authors.lastname: Fargnoli
authors.forename: Manjola
authors.initials: M
authors.lastname: Dona
authors.forename: Rossella
authors.initials: R
authors.lastname: Bertulli
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Parisi
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Fantini
authors.forename: Marta
authors.initials: M
authors.lastname: Sbaraglia
authors.forename: Mauro
authors.initials: M
authors.lastname: Panella
mesh_terms: D000328:Adult; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D004149:Dioxoles / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D060787:Neoplasm Grading; D012509:Sarcoma / Q000000981:diagnostic imaging / Q000188:drug therapy*; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D000077606:Trabectedin
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D044005:Tetrahydroisoquinolines; D000077606:Trabectedin