Cancer Treatment Today

Many patients with metastaticEwing sarcoma at diagnosis respond well to the therapy given to patients with localized disease; however, in most cases the disease is only partially controlled or recurs.

Dose-intensive chemotherapy with growth factor support is not recommended in the first-line treatment of patients with inoperable locally advanced or metastatic soft tissue sarcoma. However, for relasped disease, despite its reported survival benefit as a consolidation treatment after CC, high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT) are not routinely used in the United States for relapsed Ewing’s sarcoma (Tenneti etal). A systematic review by the same author in 2018 c aggregated twenty-four studies with total of 345 reported RES patients that got HDCT were included in final analysis. Seventeen studies had patients with multiple malignancies including RES, while seven had only RES patients. At 2 and 3-5 years, event-free survival (EFS) in studies with only RES patients ranged 42-47% and 20-61% and overall survival (OS) ranged 50-66% and 33-77%, respectively. In studies with combined patients that reported outcomes of RES separately, the EFS at 1-3 and 4 years was 36-66% and 17-50%, respectively. The OS at 1-2 and 3-4 years was 40-60% and 50-70%.

It concluded that most studies using HDCT/ASCT as consolidation regimen showed improved survival benefits compared to CC. Randomized controlled studies are needed to determine the true clinical benefits of HDCT followed by ASCT in patients with RES.

Less is known about allogeneic transplantation. Burdach concluded that EFS in AET is not improved by allogeneic SCT due to a higher complication rate. Thiel et al found that the outcome in allo-SCT treated patients was comparable to autologous-SCT in relapsed patients, and recommended further studies. Lucas in 2008 reported a case that case highlights the possibility of treating patients

Tenneti, Pavan et al. “Role of High-dose Chemotherapy and Autologous Stem Cell Transplantation for Relapsed Ewing’s Sarcoma: A Case Report with Focused Review of Literature.” Cureus vol. 10,5 e2581. 5 May. 2018, doi:10.7759/cureus.2581

Tenneti P, Zahid U, Iftikhar A, Yun S, Sohail A, Warraich Z, Anwer F. Role of High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation for Children and Young Adults with Relapsed Ewing’s Sarcoma: A Systematic Review. Sarcoma. 2018 Jun 3;2018:2640674. doi: 10.1155/2018/2640674. PMID: 29973774; PMCID: PMC6008812.

Lucas KG, Schwartz C, Kaplan J. Allogeneic stem cell transplantation in a patient with relapsed Ewing sarcoma. Pediatr Blood Cancer. 2008 Jul;51(1):142-4. doi: 10.1002/pbc.21503. PMID: 18266223.