TY - JOUR
T1 - Long-term efficacy of methotrexate plus vinblastine/Vinorelbine in a large series of patients affected by desmoid-type fibromatosis
AU - Palassini, Elena
AU - Frezza, Anna Maria
AU - Mariani, Luigi
AU - Lalli, Luca
AU - Colombo, Chiara
AU - Fiore, Marco
AU - Messina, Antonella
AU - Casale, Alessandra
AU - Morosi, Carlo
AU - Collini, Paola
AU - Stacchiotti, Silvia
AU - Casali, Paolo Giovanni
AU - Gronchi, Alessandro
PY - 2017/1/1
Y1 - 2017/1/1
N2 - Purpose: Today, surgery and radiation therapy have a limited role in desmoid-type fibromatosis. Different systemic treatments were shown to be effective. Herein, we report on our institutional experience with low-dose methotrexate (MTX) + vinca alkaloids in this disease over the last 25 years. Methods: We retrospectively reviewed data from all adult patients with sporadic desmoid-type fibromatosis treated withMTX and vinca alkaloids at our institution between 1989 and 2014. Results:We identified 75 patients treated withMTX+ vinblastine (40%), MTX + vinorelbine (57%), and vinorelbine alone (3%). All patients had progressive disease before chemotherapy; 72%, 10%, and 48% of patients had received previous surgery, radiation therapy, and/or systemic treatments, respectively. Chemotherapy was administered for amedian duration of 14 months and a median number of 37.5 cycles. Eight patients interrupted chemotherapy because of toxicity. According to RECIST (Response Evaluation Criteria in Solid Tumors) complete response, partial response, stable disease, and progressive disease were observed in 1%, 47%, 51%, and 1% of patients, respectively. Symptomatic relief was obtained in 80% of symptomatic cases. The median progression-free survival (PFS) was 75 months; it was 136 months in responding patients. Upon progression, after chemotherapy withdrawal, MTX plus vinblastine/vinorelbine was offered to 11 patients with partial response, stable disease, and progressive disease in 4, 6, and 1 cases, resulting in a median PFS of 53 months. Conclusions: In this series, chemotherapy with MTX and vinca alkaloids is confirmed to be active and effective, with a remarkable PFS, higher in responding patients, and limited toxicity. Even progression can be successfully rechallenged.
AB - Purpose: Today, surgery and radiation therapy have a limited role in desmoid-type fibromatosis. Different systemic treatments were shown to be effective. Herein, we report on our institutional experience with low-dose methotrexate (MTX) + vinca alkaloids in this disease over the last 25 years. Methods: We retrospectively reviewed data from all adult patients with sporadic desmoid-type fibromatosis treated withMTX and vinca alkaloids at our institution between 1989 and 2014. Results:We identified 75 patients treated withMTX+ vinblastine (40%), MTX + vinorelbine (57%), and vinorelbine alone (3%). All patients had progressive disease before chemotherapy; 72%, 10%, and 48% of patients had received previous surgery, radiation therapy, and/or systemic treatments, respectively. Chemotherapy was administered for amedian duration of 14 months and a median number of 37.5 cycles. Eight patients interrupted chemotherapy because of toxicity. According to RECIST (Response Evaluation Criteria in Solid Tumors) complete response, partial response, stable disease, and progressive disease were observed in 1%, 47%, 51%, and 1% of patients, respectively. Symptomatic relief was obtained in 80% of symptomatic cases. The median progression-free survival (PFS) was 75 months; it was 136 months in responding patients. Upon progression, after chemotherapy withdrawal, MTX plus vinblastine/vinorelbine was offered to 11 patients with partial response, stable disease, and progressive disease in 4, 6, and 1 cases, resulting in a median PFS of 53 months. Conclusions: In this series, chemotherapy with MTX and vinca alkaloids is confirmed to be active and effective, with a remarkable PFS, higher in responding patients, and limited toxicity. Even progression can be successfully rechallenged.
KW - Aggressive fibromatosis
KW - Chemotherapy
KW - Desmoid tumor methotrexate
KW - Desmoid-type fibromatosis
KW - Rechallenge
KW - Vinca alkaloids
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UR - http://www.scopus.com/inward/citedby.url?scp=85019002878&partnerID=8YFLogxK
U2 - 10.1097/PPO.0000000000000254
DO - 10.1097/PPO.0000000000000254
M3 - Article
C2 - 28410293
AN - SCOPUS:85019002878
VL - 23
SP - 86
EP - 91
JO - Cancer journal (Sudbury, Mass.)
JF - Cancer journal (Sudbury, Mass.)
SN - 0765-7846
IS - 2
ER -