title: Results of sub-analysis of a phase 2 study on trabectedin treatment for extraskeletal myxoid chondrosarcoma and mesenchymal chondrosarcoma.
abstract: Trabectedin is reported to be particularly effective against translocation-related sarcoma. Recently, a randomized phase 2 study in patients with translocation-related sarcomas unresponsive or intolerable to standard chemotherapy was conducted, which showed clinical benefit of trabectedin compared with best supportive care (BSC). Extraskeletal myxoid chondrosarcoma (EMCS) and Mesenchymal chondrosarcoma (MCS) are very rare malignant soft tissue sarcomas, and are associated with translocations resulting in fusion genes. In addition, the previous in vivo data showed that trabectedin affect tumor necrosis and reduction in vascularization in a xenograft model of a human high-grade chondrosarcoma. The aim of the present analysis was to clarify the efficacy of trabectedin for EMCS and MCS subjects in the randomized phase 2 study.
  
  
  
  Five subjects with EMCS and MCS received trabectedin treatment in the randomized phase 2 study. Three MCS subjects were allocated to the BSC group. Objective response and progression-free survival (PFS) were assessed according to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 by central radiology imaging review.
  
  
  
  The median follow-up time of the randomized phase 2 study was 22.7 months, and one subject with MCS was still receiving trabectedin treatment at the final data cutoff. The median PFS was 12.5 months (95 % CI: 7.4-not reached) in the trabectedin group, while 1.0 months (95 % CI: 0.3-1.0 months) in MCS subjects of the BSC group. The six-month progression-free rate was 100 % in the trabectedin group. One subject with MCS showed partial response, and the others in the trabectedin group showed stable disease. Overall survival of EMCS and MCS subjects was 26.4 months (range, 10.4-26.4 months) in the trabectedin group. At the final data cutoff, two of five subjects were still alive.
  
  
  
  This sub-analysis shows that trabectedin is effective for patients with EMCS and MCS compared with BSC. The efficacy results were better than previously reported data of TRS. These facts suggest that trabectedin become an important choice of treatment for patients with advanced EMCS or MCS who failed or were intolerable to standard chemotherapy.
  
  
  
  The randomized phase 2 study is registered with the Japan Pharmaceutical Information Center, number JapicCTI-121850 (May 31, 2012).
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan. morioka.z3@keio.jp.
authors.forename: Hideo
authors.initials: H
authors.lastname: Morioka
authors.affiliation: Department of Medical Oncology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Takahashi
authors.affiliation: Department of Orthopaedic Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Nobuhito
authors.initials: N
authors.lastname: Araki
authors.affiliation: Department of Orthopaedic Surgery, Aichi Cancer Center Hospital, Aichi, Japan.
authors.forename: Hideshi
authors.initials: H
authors.lastname: Sugiura
authors.affiliation: Department of Orthopaedic Surgery, Osaka National Hospital, Osaka, Japan.
authors.forename: Takafumi
authors.initials: T
authors.lastname: Ueda
authors.affiliation: Division of Orthopaedic Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan.
authors.forename: Mitsuru
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: Division of Orthopaedic Surgery, Chiba Cancer Center, Chiba, Japan.
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Yonemoto
authors.affiliation: Department of Orthopaedic Surgery, Hokkaido Cancer Center, Hokkaido, Japan.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Hiraga
authors.affiliation: Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Kanagawa, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Hiruma
authors.affiliation: Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Kunisada
authors.affiliation: Department of Orthopedic Surgery, Mie University Graduate School of Medicine, Mie, Japan.
authors.forename: Akihiko
authors.initials: A
authors.lastname: Matsumine
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Michiro
authors.initials: M
authors.lastname: Susa
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Robert
authors.initials: R
authors.lastname: Nakayama
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Kazumasa
authors.initials: K
authors.lastname: Nishimoto
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Kazutaka
authors.initials: K
authors.lastname: Kikuta
authors.affiliation: Department of Orthopaedic Surgery, Keio University School of Medicine, 35 Shinanomachi Shinjuku-ku, Tokyo, 160-8582, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Horiuchi
authors.affiliation: Department of Musculoskeletal Oncology, Rare Cancer Center, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Kawai
mesh_terms: D000328:Adult; D000368:Aged; D018906:Antineoplastic Agents, Alkylating / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000401:mortality; D002813:Chondrosarcoma / Q000188:drug therapy* / Q000401:mortality; D018211:Chondrosarcoma, Mesenchymal / Q000188:drug therapy* / Q000401:mortality; D004149:Dioxoles / Q000627:therapeutic use*; D018572:Disease-Free Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008875:Middle Aged; D018204:Neoplasms, Connective and Soft Tissue / Q000188:drug therapy* / Q000401:mortality; D044005:Tetrahydroisoquinolines / Q000627:therapeutic use*; D000077606:Trabectedin; D016896:Treatment Outcome
chemical_list: D018906:Antineoplastic Agents, Alkylating; D004149:Dioxoles; D044005:Tetrahydroisoquinolines; D000077606:Trabectedin
keywords: Chemotherapy; Extraskeletal myxoid chondrosarcoma; Mesenchymal chondrosarcoma; Trabectedin; Translocation-related sarcoma