From the Guidelines
For second-line treatment of metastatic liposarcoma after doxorubicin failure, eribulin is the preferred option, as it has shown superiority over dacarbazine in patients with liposarcomas, with a median difference in overall survival of 2 months, and up to 7 months in certain subtypes. When considering second-line therapy for metastatic liposarcoma, several factors come into play, including the specific subtype of liposarcoma, patient performance status, and prior treatments. According to the most recent guidelines, including those from the ESMO-EURACAN-GENTURIS clinical practice guidelines for diagnosis, treatment, and follow-up of soft tissue and visceral sarcomas 1, and the SELNET clinical practice guidelines for soft tissue sarcoma and GIST 1, eribulin has emerged as a key option for second-line treatment in liposarcoma patients who have progressed after doxorubicin. Some key points to consider in the decision-making process include:
- Eribulin's efficacy in liposarcoma, particularly in pleomorphic liposarcoma, with improved overall survival compared to dacarbazine 1.
- The potential role of trabectedin in certain liposarcoma subtypes, such as myxoid/round cell liposarcoma, although its use may depend on specific patient and tumor characteristics 1.
- Pazopanib's limited efficacy in liposarcomas, despite its approval for soft tissue sarcomas, making it less preferred for this specific subtype 1.
- Ifosfamide's use in second-line therapy, particularly in patients who have not previously progressed on it, with high-dose ifosfamide being an option for those who have received standard-dose ifosfamide 1. Ultimately, the choice of second-line therapy should be individualized, taking into account the patient's overall health, tumor characteristics, and prior treatments, with the goal of optimizing outcomes in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Second-Line Treatment Options for Metastatic Liposarcoma
- Ifosfamide and pazopanib are considered as second-line treatment options for metastatic liposarcoma after first-line chemotherapy with doxorubicin.
- According to the study 2, pazopanib has shown potential activity in liposarcoma, with a progression-free rate at 12 weeks of 68.3% and a median progression-free survival of 4.4 months.
- Ifosfamide, on the other hand, has been studied in combination with doxorubicin as a first-line treatment for soft tissue sarcoma, including liposarcoma 3, 4, 5.
- The study 5 specifically looked at the efficacy of first-line doxorubicin and ifosfamide in myxoid liposarcoma, showing an overall response rate of 43.2% using RECIST criteria and 86.5% using the Choi criteria.
- However, the study 6 compared doxorubicin plus palifosfamide (the active metabolite of ifosfamide) with doxorubicin plus placebo in patients with metastatic soft tissue sarcoma, and found no significant difference in progression-free survival between the two arms.
Comparison of Ifosfamide and Pazopanib
- Both ifosfamide and pazopanib have shown activity in metastatic liposarcoma, but the choice of second-line treatment depends on various factors, including patient tolerance, toxicity profile, and disease characteristics.
- Ifosfamide is a chemotherapy agent that has been used in combination with doxorubicin as a first-line treatment, while pazopanib is a tyrosine kinase inhibitor that has shown potential activity in liposarcoma as a single agent 2.
- The study 3 suggested that combination therapy comprising pegylated liposomal doxorubicin and ifosfamide is an effective and well-tolerated first-line treatment for patients with advanced or metastatic soft tissue sarcoma, but the efficacy of ifosfamide as a second-line treatment after doxorubicin is not well established.
- In contrast, the study 2 provides evidence of potential activity of pazopanib in liposarcoma, making it a possible option for second-line treatment.