Introduction
Dedifferentiated liposarcoma (DDLPS) is a rare and aggressive variant of soft-tissue sarcoma, accounting for approximately 10% of all liposarcomas. Despite multimodal treatment approaches, the prognosis for DDLPS patients remains poor, with a 5-year overall survival rate of around 30%. This highlights the urgent need for innovative therapeutic strategies.
Case Study Overview
A 63-year-old male patient with advanced and unresectable DDLPS was treated with a combination of trabectedin and nivolumab, a PD-1 inhibitor, as part of the NitraSarc trial. The patient had previously undergone multiple surgeries and chemotherapy cycles, experiencing several relapses.
Treatment and Outcomes
- Initial Treatment: The patient received trabectedin monotherapy, leading to disease stabilization and a slight tumor regression of -26% after three cycles.
- Combination Therapy: Nivolumab was added starting from cycle 4, resulting in a deepened response to a partial response (-86%) according to RECIST 1.1 criteria.
- Long-term Control: After eleven cycles, trabectedin was discontinued due to infectious complications, and the patient continued with nivolumab monotherapy. Remarkably, the patient achieved a no evidence of disease (NED) status and has been living with DDLPS for 9.3 years, including 4.3 years without any treatment.
Discussion
This case study complements findings from the SARC028 trial, which investigated the efficacy of PD-1 inhibitors in soft-tissue sarcomas. While previous studies showed limited activity in liposarcoma patients, the combination of trabectedin and PD-1 inhibition demonstrated exceptional response duration in this case. The findings suggest that trabectedin may prime the sarcoma microenvironment for enhanced responsiveness to PD-1 inhibition.
Conclusion
The case underscores the potential of trabectedin followed by PD-1 inhibition as a therapeutic strategy for DDLPS. Further research is needed to identify biomarkers that predict response to checkpoint inhibitors and to explore the optimal timing and combination of these treatments. The ongoing NitraSarc trial may provide additional insights into the efficacy of this approach.
References
- Frontiers in Oncology: Long-term disease control in dedifferentiated liposarcoma: a case report on trabectedin
