[Expert consensus on the application of antiangiogenic tyrosine kinase inhibitors in sarcomas (2026 edition)].

Abstract

Bone and soft tissue sarcomas are highly heterogeneous malignant tumors originating from mesenchymal tissues. 20%-25% of bone and 10%-15% of soft tissue sarcoma patients present with metastases at diagnosis, with another 30%-50% progressing during treatment. Currently, chemotherapy remains the primary first-line treatment for advanced disease. However, standard protocols for second-line and subsequent treatments are lacking, and immunotherapy is effective only in limited subtypes. Anti-angiogenic tyrosine kinase inhibitor (TKI), by inhibiting angiogenesis and remodeling the tumor microenvironment, has demonstrated promising clinical prospects, expanding their application scope from second-line and subsequent therapies to first-line combination TKI, maintenance, and neoadjuvant settings. To standardize the clinical application of TKI, the Sarcoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO) organized 51 experts and developed this consensus based on the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, systematically integrating domestic and international evidence-based medical data up to October 2025, combined with expert clinical experience. This consensus focuses on the application of TKI in bone and soft tissue sarcomas, identifies the 8 core clinical questions and formulates 12 recommendations covering indication selection, timing of administration, combination strategies, perioperative management, and adverse event management, aiming to provide scientific guidance for Chinese clinicians to standardize their use in sarcoma treatment, enhance therapeutic efficacy, and improve patient prognosis.