Managing Epithelioid Sarcoma: Follow-Up Strategies and Treatment Decisions for Stable Disease vs Progression
Panelists discuss how conventional chemotherapy remains a key frontline treatment for advanced or metastatic epithelioid sarcoma (ES), while emerging targeted therapies, guided by molecular profiling and biomarkers like INI1 loss, offer personalized treatment options for patients with specific molecular alterations.
Summary for Physicians: Frontline Treatment Strategies for Advanced or Metastatic ES
Role of Conventional Chemotherapy: Conventional chemotherapy remains a cornerstone in the treatment of advanced or metastatic ES, particularly in patients with aggressive disease or those who are not candidates for surgery or radiation. Common chemotherapy options include ifosfamide and gemcitabine, often used in combination to improve efficacy. Chemotherapy is preferred in patients with rapidly progressing disease or those who require systemic treatment due to widespread metastasis. Patient factors such as performance status, prior treatment history, and potential for adverse effects guide the decision to select chemotherapy. The choice of regimen depends on the balance between efficacy and toxicity, with clinical considerations such as comorbidities influencing treatment decisions.
Role of Targeted Therapy: Targeted therapies are increasingly explored in the frontline setting, particularly for patients whose tumors exhibit specific molecular characteristics. Options may include agents targeting key pathways involved in ES, such as those related to the INI1 (SMARCB1) loss. Targeted therapy may be preferred in patients with molecular alterations that predict sensitivity to specific drugs. The decision to opt for targeted therapy is often based on the availability of biomarkers, the patient’s molecular profile, and previous treatment responses.
Biomarker testing, including genomic profiling, plays an integral role in selecting patients for targeted therapies, helping to identify those with actionable mutations or pathways amenable to treatment. These tests can provide insights into which therapies may be most effective and help personalize treatment decisions for individual patients.
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Stay up to date on recent advances in the multidisciplinary approach to cancer.
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