RJS-010

A phase II trial by German researchers has shown that bendamustine, a bifunctional alkylating drug, shows encouraging results in patients with advanced soft-tissue sarcoma (STS; Cancer, published online June 28, 2007; DOI: 10.1002/cncr.22846). Joerg Hartmann (Eberhard-Karls University, Tuebingen, Germany) and co-workers noted that for patients with advanced STS, although anthra cyclines and ifosfamide have substantial single-agent activity, no standard treatment option exists for patients who fail previous treatment with these two drugs. The researchers therefore aimed to assess the effi cacy of bendamustine (which shows no cross-resistance with anthracyclines and ifosfamide) in 36 patients with metastatic STS (aged 18–79 years), who were previously treated with anthracyclines or ifosfamide or both. Most (n=20) of these patients had shown disease progression on previous treatment. Bendamustine was given as second-line treatment in 21 patients and as thirdline treatment in 15. A 30-minute intra venous infusion at a dose of 100 mg/m was given on days 1 and 2, repeated every 28 days. A total of 101 cycles of treatment were given (median=2 cycles; range=1–8). One patient achieved partial remission and 11 had stable disease. In an intention-to-treat an aly sis, progression-free survival was 35·3% (95% CI 19·3–51·3%) at 3 months and 20·6% (7·1–34·1%) at 6 months. Six of the 15 patients who had leiomyosarcoma histology showed disease stabilisation. Toxic eff ects were mild to moderate. Grade 3 toxic eff ects (according to the National Cancer Institute Common Toxicity Criteria) included anaemia in three patients, leucopenia in four patients, and thrombocytopenia, non-neutropenic fever, and an allergic reaction in one patient each. “Bendamustine may be as eff ective as other compounds but has a more convenient toxicity profi le”, says Hartmann. “The drug is well tolerated and has some activity, particularly in patients with leiomyosarcoma histology”, he adds. Gautam Das (Calcutta National Medical College, Calcutta, India) comments, “metastatic STS has a poor prognosis—the median overall survival in patients with metastatic STS is just 1 year, and the treatment options for these patients are also very limited”. Therefore, this study is impressive, but we should wait for the results of a phase III trial, he adds.

Doxorubicin and cisplatin are the most commonly used chemotherapeutic agents in the treatment of endometrial cancer, but their clinical efficacy is still controversial. The aim of this study was to retrospectively assess the efficacy and toxicity of combination chemotherapy using cisplatin, cyclophosphamide, and anthracy-clines in patients with stage III/IV adenocarcinoma of the endometrium.

Forty patients with advanced endometrial cancer received postoperative adjuvant combination chemotherapy, using cisplatin (50 or 70 mg/m2), cyclophosphamide (500 mg/m2), and one of three anthracyclines (10 patients with doxorubicin [50 mg/m2], 18 with epirubicin [50 mg/m2], and 12 with pirarubicin [40 mg/m2]), from 1987 to 1999. All patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, with pelvic lymph node dissection in 36 patients and paraaortic lymph node biopsy in 38 patients. Patients were considered eligible if they had adnexal metastasis, paraaortic lymph node metastasis, positive peritoneal cytology, or distant metastasis. The patients were divided into two groups: patients with no measurable lesion (group 1; n = 27), and those with residual measurable lesion (group 2; n = 13) after surgery. The response rate and progression-free survival rate were evaluated in group 2.

In group 1, 7 patients (26%) had recurrence, and all of them died of the disease. No patients in stage IIIa (n = 10), however, had recurrence. In group 2, 6 of the 13 (46%) showed response to chemotherapy (complete response [CR], 31%; partial response [PR], 15%). Toxicity was moderate: 10 patients had grade 4 neutropenia; and dose reductions were mandated in 12 patients.

In group 1, the survival of patients receiving chemotherapy was considered favorable, but patients with recurrent lesions had poor prognosis. On the other hand, in group 2, the efficacy of the chemotherapy was almost equal to that reported in the literature; however, this regimen did not contribute to an improvement in the survival rate. In conclusion, a new effective regimen of postoperative adjuvant therapy is highly desirable in patients with measurable residual lesions.