Identifying Uses for Immunotherapy Across Sarcoma Populations and Subtypes

In a conversation with CancerNetwork^® at the 3rd Biennial Miami Precision Medicine Conference, Steven Bialick, DO, highlighted precision medicine strategies that may help identify patients with sarcoma who could benefit from treatment with immunotherapy. According to Bialick, immunotherapy has produced limited efficacy for many sarcoma types, although this drug class may have select uses.

Bialick, a gastrointestinal and sarcoma and connective tissue medical oncologist at the University of Miami Sylvester Comprehensive Cancer Center, highlighted that subcutaneous atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) has demonstrated efficacy among patients with alveolar soft part sarcoma, which resulted in the agent’s FDA approval for this patient population in September 2024.¹ He also noted that patients who are unsuitable to receive chemotherapy due to comorbidities, age, or functional status may benefit from agents like pembrolizumab (Keytruda) if they present with microsatellite instability-high (MSI-H) disease.

Transcript:

Historically, immunotherapy hasn't been the mainstay for a lot of sarcomas because of its lack of efficacy. More recently—[in] 2024—there was another specific sarcoma subtype called alveolar soft part sarcoma, where the use of atezolizumab, a PD-L1 inhibitor, showed really good efficacy. That became an FDA-approved drug indication for that particular subtype. Using molecular profiling or next-generation sequencing [NGS] to identify patients who have MSI-H disease would automatically indicate that we think those patients would do well with immunotherapy.

I have patients in my clinic who either don't qualify for chemotherapy because of their comorbidities, age, or functional status, but they have an MSI-H tumor that some patients with the same exact sarcoma may not exhibit. [For] those patients, we talk about putting them on drugs like pembrolizumab for the sheer fact that they have MSI-H disease. It's not common, but without testing for it, we wouldn't know. [It is] another reason why we, in our group at least, feel so strongly about using precision medicine or molecular testing for these patients to identify features like that.

Reference

FDA approves atezolizumab and hyaluronidase-tqjs for subcutaneous injection. News release. FDA. September 12, 2024. Accessed September 12, 2024. https://shorturl.at/6T2C8