Irinotecan and temozolomide in adults with recurrent sarcoma

Background: The combination of irinotecan and temozolomide (IT) has shown promising activity in children treated for recurrent sarcoma. This study investigates the safety and efficacy of IT chemotherapy in adults with recurrent sarcoma. Materials/Methods: A retrospective review was performed on patients with recurrent sarcoma who received IT chemotherapy from 2009-2013. Outcomes of interest were time to treatment failure (TTF) and incidence of toxicity. Results: IT chemotherapy was used in 24 patients including: Ewing’s sarcoma (EWS, n=11, 46%); non-pleomorphic rhabdomyosarcoma (RMS, n=6, 25%); desmoplastic small round cell tumor (DSRCT, n=6, 25%); and leiomyosarcoma (n=1, 4%). Median TTF was 3.0 months (range 1.6-4.4). Partial responses were observed in 4 patients (17%), stable disease in 9 patients (37%) and progressive disease in 11 patients (46%). Grade 3 hematologic toxicity was as follows: anemia (n=5, 21%); neutropenia (n=3, 12%); and thrombocytopenia (n=1, 4%). Diarrhea was reported among 12 patients (50%) and 3 patients (12%) experienced severe diarrhea requiring hospitalization. Conclusion: IT chemotherapy is tolerable with modest activity and represents a reasonable choice for adults with recurrent EWS or DSCRT.  Further prospective studies aimed at this high risk population are warranted.