Pick your poison.

Top Line: Doxorubicin-based chemo is the standard first-line therapy for advanced, metastatic sarcoma.

The Study: But it can be difficult, especially for older patients and especially considering a lack of expected blockbuster results. The phase 2 EPAZ study randomized patients 60 years and older with metastatic sarcoma to single-agent doxorubicin versus the multiple kinase inhibitor pazopanib. The goal of the study was to see if non-inferior disease outcomes with less toxicity (specifically neutropenia) could be achieved with pazopanib. The rates of dose reduction and treatment discontinuation were similar between arms. Interestingly, however, more patients discontinued pazopanib due to toxicity and more patients crossed-over to second-line doxorubicin than did the reverse. Median progression-free survival was indeed non-inferior (4-5 months), but response rate was low in both arms (12-15%). While there was no difference in the overall rate of toxicity, there was a big decrease in grade 4 neutropenia (56 → 0%) and febrile neutropenia (10 → 0%) with pazopanib.

TBL: In older patients with advanced sarcoma, pazopanib offers a comparable (meaning not great) treatment alternative to doxorubicin with a different side effect profile. | Grunwald, J Clin Oncol 2020

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