Successful sequential antiangiogenic therapy for ASPS

[Fictional]

I don't have the paper yet - but perhaps some of you who have access to University journals could see if you could get this and share? I don't want to buy it.

Sounds like an interesting title. There are many lines of evidence suggesting that sequential therapy would work in ASPS. Would be nice to find out what the endpoint was and exactly what agents were used. I emailed Strumberg - maybe he will send me the paper. If so, I will add it to this thread.

Int J Clin Pharmacol Ther. 2010 Jul;48(7):468-9.
Successful sequential antiangiogenic therapy for alveolar soft part sarcoma - a case report

Schultheis B, Kummer G, Tannapfel A, Strumberg D.

[Arch]

This is something that I found..

http://www.cesar.or.at/download/text/19 ... t%2011.pdf

It talks about an ASPS patient who had benefit with Cediranib for a year until resistance developed and he started progressing. He was started on sorafenib
and bevacizumab and again saw stabilisation of his tumors for 9 months(it doesn't say that he progressed after 9 months, so not sure if he continues to be stable).

[Fictional]

This is great, Arch. It's very valuable to have some of this in writing. This is exactly analogous to the findings in renal CA - switching to different antiangiogenic agents helped reduce the growth of other clones. In fact switching between Sutent, Avastin, and Nexavar, and then repeating the cycle resulted in greater response rate and longer duration. And retrial of a medication that a patient had stopped responding to several meds ago - resulted in continued response. So for instance, if someone were on Cediranib, and started to progress, switching to Sutent - getting benefit from that - then when that seemed to stop working, switching back to Cediranib might still make sense. The only way to practically do this though is to have Cediranib approved. Hopefully it will not be too long off.

Would think that Sutent might even be better than Sorafenib + Avastin - given previous ASPS marginal responses to Avastin / Nexvar in the past.

It is especially good to have this in print - because there is talk of the FDA being more aggressive about removing Avastin from approval (so insurance won't pay) - they are now planning to pull for use in breast cancer. Even though it is anecdotal, as long as it is published and we have a rare cancer, it can be used to appeal insurance coverage decisions.

The discussion of clones also totally makes sense. Molecularly there were some differences in tumors that we profiled. It makes it exasperating though when 15 mets show no growth on a trial, but 1 continues to grow - and that one causes an ASPS patient to be kicked out of a trial...followed by off all medications and all of the tumors are growing.

We are getting much more into the sequential therapy mindset - take what you can from a drug and if you have to leave, switch to something else.

[Bonni Hess]

Thank you for sharing the link for this very important and relevant information Arch, and thank you for your always valued input and very knowledgeable shared information 'F'. The encouraging data regarding the success of a sequential antiangiogenic medication approach to TKI treatment echoes what we have been told by Dr. Sawyer regarding possible treatment options if Brittany heartbreakingly eventually develops resistance to her Cediranib treatment. Of course, as 'F' has noted, a concerning issue would be the accessibility of Cediranib as a medication to resume taking until it has received FDA approval and becomes available off Trial on a prescription basis. However, if and when Cediranib receives FDA approval, it may be cost prohibitive for patients and their families off Trial (Sutent is about $6000 per month!) unless the insurance companies will allow coverage of the drug. We must all remain vigilant and active in advocating for better medication coverage for orphan diseases like ASPS to ensure affordable access for patients to promising new medications like Cediranib.
With special caring thoughts and continued Hope,
Bonni