title: Patterns of care and outcomes of patients with METAstatic soft tissue SARComa in a real-life setting: the METASARC observational study.
abstract: BACKGROUND
  Well-designed observational studies of individuals with rare tumors are needed to improve patient care, clinical investigations, and the education of healthcare professionals.
  
  
  METHODS
  The patterns of care, outcomes, and prognostic factors of a cohort of 2225 patients with metastatic soft tissue sarcomas who were diagnosed between 1990 and 2013 and documented in the prospectively maintained database of the French Sarcoma Group were analyzed.
  
  
  RESULTS
  The median number of systemic treatments was 3 (range, 1-6); 27% of the patients did not receive any systemic treatment and 1054 (49%) patients underwent locoregional treatment of the metastasis. Half of the patients who underwent chemotherapy (n = 810) received an off-label drug. Leiomyosarcoma was associated with a significantly better outcome than the other histological subtypes. With the exception of leiomyosarcomas, the benefit of a greater than third-line regimen was very limited, with a median time to next treatment (TNT) and overall survival (OS) ranging between 2.3 and 3.7 months and 5.4 and 8.5 months, respectively. The TNT was highly correlated with OS. Female sex, leiomyosarcoma histology, locoregional treatment of metastases, inclusion in a clinical trial, and treatment with first-line polychemotherapy were significantly associated with improved OS in the multivariate analysis.
  
  
  CONCLUSIONS
  The combination of doxorubicin with a second drug, such as ifosfamide, represents a valid option, particularly when tumor shrinkage is expected to provide clinical benefits. After failure of the second-line therapy, best supportive care should be considered, particularly in patients with non-leiomyosarcoma histology who are not eligible to participate in a clinical trial. Locoregional treatment of metastasis should always be included in the therapeutic strategy when feasible. TNT may represent a useful surrogate endpoint for OS in clinical studies.
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.|ISPED, INSERM U1219 Bordeaux Population Health Center, Epicene Team, Bordeaux, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Savina
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejui, France.
authors.forename: Axel
authors.initials: A
authors.lastname: Le Cesne
authors.affiliation: Department of Medicine, Centre Leon Berard, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Department of Medicine, Centre Leon Berard, Lyon, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Ray-Coquard
authors.affiliation: Department of Medicine, Institut Gustave Roussy, Villejui, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Mir
authors.affiliation: Department of Medicine, Institut Bergonié, Bordeaux, France.
authors.forename: Maud
authors.initials: M
authors.lastname: Toulmonde
authors.affiliation: Department of Medicine, Institut Bergonié, Bordeaux, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Cousin
authors.affiliation: Department of Pathology, Institut Gustave Roussy, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Terrier
authors.affiliation: Department of Pathology, Centre Leon Berard, Lyon, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Ranchere-Vince
authors.affiliation: Department of Surgery, Centre Leon Berard, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Meeus
authors.affiliation: Department of Surgery, Institut Bergonié, Bordeaux, France.
authors.forename: Eberhard
authors.initials: E
authors.lastname: Stoeckle
authors.affiliation: Department of Surgery, Institut Gustave Roussy, Villejuif, France.
authors.forename: Charles
authors.initials: C
authors.lastname: Honoré
authors.affiliation: Department of Radiotherapy, Institut Bergonié, Bordeaux, France.
authors.forename: Paul
authors.initials: P
authors.lastname: Sargos
authors.affiliation: Department of Radiotherapy, Centre Leon Berard, Lyon, France.
authors.forename: Marie-Pierre
authors.initials: MP
authors.lastname: Sunyach
authors.affiliation: Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Le Péchoux
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Giraud
authors.affiliation: Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France.|ISPED, INSERM U1219 Bordeaux Population Health Center, Epicene Team, Bordeaux, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Bellera
authors.affiliation: Department of Pathology, Institut Bergonié, Bordeaux, France.
authors.forename: François
authors.initials: F
authors.lastname: Le Loarer
authors.affiliation: Department of Medicine, Institut Bergonié, Bordeaux, France. a.italiano@bordeaux.unicancer.fr.|Early Phase Trials and Sarcoma Units, Institut Bergonié, 229 Cours de l'Argonne, Bordeaux, France. a.italiano@bordeaux.unicancer.fr.
authors.forename: Antoine
authors.initials: A
authors.lastname: Italiano
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D004317:Doxorubicin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data; D012509:Sarcoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012983:Soft Tissue Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D004317:Doxorubicin
keywords: Chemotherapy; Metastases; Outcome; Patterns of care; Sarcoma; Surgery