|
| Recommendation | Phase | Type of consensus (% agreement) |
|
| Optimal treatment following progression to first-line chemotherapy should | | |
| (i) Include the maximum possible number of drugs or regimens, to be used sequentially following failure of a previous treatment, provided the patient maintains an adequate performance status | 1 | Yes (85) |
| (ii) Be initiated with the most active therapy available for each case, taking into account both histotype and specific patient characteristics, as in subsequent lines efficacy will decrease | 1 | Yes (90) |
| (iii) Given the palliative context, give priority to less toxic alternatives as they have a less negative impact on the quality of life | 1 | Yes (80) |
| The following factors should be considered when selecting second-line treatment (in decreasing order of importance): | | |
| (i) Comorbidity, age, and performance status of the patient | 2 | Yes (mean: 3.8; CV: 11.9%) |
| (ii) The sarcoma histological subtype | 2 | Yes (mean: 3.6; CV: 25.2%) |
| (iii) Toxicity to first-line chemotherapy | 2 | Yes (mean: 1.6; CV: 38.1%) |
| (iv) Response to first-line chemotherapy | 2 | Yes (mean: 1.6; CV: 40.3%) |
| (1) Trabectedin has a favorable toxicity profile compared to classic chemotherapy agents and constitutes a second-line option that is always worth considering when treating STS | 1 | Yes (90) |
| (2) Numerous data on activity in sarcoma subtypes other than leiomyosarcoma or liposarcoma, such as synovial sarcoma, support the possibility of also using trabectedin to treat these STS subtypes | 1 | Yes (75) |
| (3) Treatment with trabectedin is an especially recommended option for myxoid liposarcoma | 1 | Yes (100) |
| (4) Treatment with trabectedin until progression may extend time to progression and is an option worth considering for patients as it shows clinical benefit and acceptable tolerance | 1 | Yes (95) |
| (5) Rechallenge with trabectedin after progression in patients who previously achieved a good response may be an option to consider for select patients | 1 | Yes (75) |
| (6) Given its toxicity and complex administration schedule, ifosfamide is preferably indicated for certain subtypes and for cases in which the therapeutic objective is to achieve a rapid response | 2 | Yes (68.8) |
| (7) Other more appropriate alternatives than ifosfamide should be considered for second-line treatment of leiomyosarcoma | 2 | Yes (93.8) |
| (8) Due to its toxicity profile, which is different from that of chemotherapy agents, pazopanib may prove to be an advantage in patients with significant toxicity to previous lines | 1 | Yes (90) |
| (9) Pazopanib should never be used for the treatment of liposarcomas | 2 | Yes (87.5) |
| (10) Pazopanib constitutes an adequate option for second-line and subsequent treatment of nonadipocytic STS | 2 | Yes (68.8) |
| (11) Blood pressure and hepatic and thyroid function should be monitored during treatment with pazopanib | 2 | Yes (93.8) |
| (12) Overall, the combination of gemcitabine and DTIC has a better tolerance profile than gemcitabine plus docetaxel | 1 | Yes (95) |
| (13) The combination of gemcitabine and DTIC may be a treatment alternative to be considered for leiomyosarcoma as well as the rest of STS | 1 | Yes (90) |
| (14) Given its lower activity compared to other available drugs, DTIC should no longer be used for standard control arm patients in randomized second-line clinical trials | 1 | Yes (70) |
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