JSCO2016: International Session 22 Bone and Soft Tissue Tumor

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The 54th Annual Meeting of Japan Society of Clinical Oncology (JSCO2016)

"Renovation of Cancer Medicine in the Mature Society"



International Session 1: Lung Cancer
International Session 2: Colorectal Cancer
International Session 3: Gastric Cancer
International Session 4: Urological Cancer (Prostate and Renal Cancer)
International Session 5: Supportive Care for Adverse Events
International Session 6: Gynecological Cancer (Uterine Body Cancer and Ovarian Cancer)
International Session 7: Central Nervous System Tumor
International Session 8: New Development of Particle Beam Therapy for Cancer
International Session 9: International Cooperation in Radiation Medicine
International Session 10: Recent Advances In Cancer Immunotherapy
International Session 11: Breast Cancer
International Session 12: Pharmacology of Antitumor Agents: New Drug Application (NDA)
International Session 13: Malignant Lymphoma
International Session 14: Palliative Care
International Session 15: Radiation Therapy
International Session 16: Head and Neck Cancer
International Session 17: Skin Cancer (Malignant Melanoma)
International Session 18: Hepato-Biliary and Pancreas Cancers
International Session 19: Leukemia
International Session 20: Ethics for Clinical Research
International Session 21: Esophageal Cancer
International Session 22: Bone and Soft Tissue Tumor
FACO/JSCO Joint Symposium

Abstract Archives (in Japanese)


International Session 22: Bone and Soft Tissue Tumor


Treatment guidelines for musculoskeletal sarcoma in Japan
Hiroyuki Tsuchiya (Orthopaedic, Kanazawa University Graduate School of Medical Science)
The Japan Orthopaedic Association (JOA) published treatment guidelines for soft tissue tumors in 2005. Guidelines for bone tumors are currently being developed by JOA and will be published soon. Guidelines for childhood cancers, including osteosarcoma, Ewing sarcoma, and rhabdomyosarcoma, were published in 2011.

Guidelines for soft tissue tumors are intended to give health professionals the knowledge required to provide optimal care to patients. The original version of the guidelines was developed by a working party of orthopedic oncologists who specialized in the treatment of patients with soft tissue tumors. The second version of the guidelines for soft tissue tumors was published in 2012 and next version is also being developed.

Other publications in Japan are widely used as reference books for management of bone and soft tissue sarcoma, including "Today's Therapy" and "General Rules for Clinical and Pathological Studies on Malignant Bone and Soft Tissue Tumors."

In the clinic, due to a lower number of bone and soft tissue sarcoma patients compared to major cancers, we sometimes need to treat patients in the absence of strong evidence. Discrepancies between guidelines and health insurance coverage may exist, which can cause anxiety. Prospective clinical studies continue to be conducted by Japan Clinical Oncology Group (JCOG) or Japan Musculoskeletal Oncology Group (JMOG) to obtain stronger evidence to support various sarcoma treatment strategies.

Recommended treatment of osteosarcoma is chemotherapy with MTX, DXR, CDDP, and IFM for 6 to 8 months, as well as tumor excision with wide margins. Round cell sarcomas require chemotherapy, while other soft tissue sarcomas require only surgical excision and the efficacy of chemotherapy is unclear. Recently, a meta-analysis revealed the efficacy of DXR and IFM for soft tissue sarcoma.


New therapapeutic developments in sarcoma: Molecular diagnosis and treatment of sarcomas
Jean-Yves Blay (University Claude Bernard Lyon I and Centre Leon Berard, Lyon, France)
The understanding of the nosological classification and biology of sarcomas and locally aggressive connective tissue tumors has evolved rapidly in the last decade. Several molecular subgroups may be distinguished (1): 1) sarcoma with specific translocations generating fusion transcription factors or growth factors; 2) sarcomas with mutated activated kinases (KIT in GIST); 3) sarcomas with deletion of tumor suppressor genes such as NF1 sarcomas; 4) Sarcomas with simple genetic alterations (MDM2/CDK4 gene amplification in WD/DD liposarcomas; 5) Tumors with alterations of the intercellular adhesion pathways; 6) Finally, sarcomas with gross genetic alterations (e.g. leiomyosarcomas, UPS). This biological classification rapidly evolves and guides in real time the development of novel treatments (2).
The identification of the "driver" mutations in GIST has guided the selection of targeted therapies for early clinical development: in inflammatory myofibroblastic tumors (IMT) with Alk TKIs, in DFSP, a PDGF driven tumor and in PVNS, an M-CSF driven tumor. For this later group, 2 novel MCSFR inhibitors have been shown to have an outstanding clinical activity in recent papers. This concept has therefore been fruitful, but now shows limitations, as observed with IGF1R Ab, or less dramatic activity such as MDM2 inhibitors or CDK4 inhibitors as single agents. In addition, tumor heterogeneity, in the primary tumor, in the metastases, and following exposure to a TKI are now frequently observed, calling for innovative strategies to overcome this common phenomenon. More recently the emergence of immunotherapy with immune check points inhibitor has arisen as a potential tool for this heterogenous group of diseases. (3). During this presentation, we will review how the understanding of the driver molecular alterations of these tumors paved the way for the development of targeted treatment inhibiting driver mutations, and discuss the next steps to be explored.


Bone and soft tissue tumors in Japan: The year in review 2016
Akira Kawai (Division of Musculoskeletal Oncology, National Cancer Center)
The current review covers various topics related to bone and soft tissue sarcomas in Japan over the past year. There has been significant progress in the fields of sarcoma management, surgery, chemotherapy, and radiotherapy.
The surgical margin is an important issue in tumor surgery, and has implications for oncological and functional outcomes. Based on analysis of more than a thousand cases that had originally been evaluated according to the 1989 Japanese Orthopaedic Association (JOA) system, a new evaluation method has been proposed by the Cancer Institute Hospital. Prospective data collection and verification of the accuracy of this new method will be necessary.
Development of novel chemotherapeutic agents for sarcomas has been one of the most exciting fields of musculoskeletal oncology in recent years. Since the introduction of pazopanib (2012), trabectedin (September 2015) and eribulin (February 2016) have been approved by the Ministry of Health, Labour and Welfare for treatment of advanced soft tissue sarcomas (STS). An international phase III trial of doxorubicin plus olaratumab in patients with advanced or metastatic STS is now underway.
Carbon ion radiotherapy has been approved for the treatment of sarcomas that are not amenable to surgical resection. The introduction of this cutting-edge technology to oncology has been led through the pioneering efforts of the National Institute of Radiological Sciences. Inoperable chordoma and osteosarcoma in the pelvis are prime candidates for carbon ion radiotherapy.
In the field of rare cancers such as sarcomas, multi-institutional collaboration is very important. The Bone and Soft Tissue Study Group of the Japan Clinical Oncology Group (JCOG) is conducting two multi-institutional clinical studies: JCOG0905 for osteosarcoma and JCOG1306 for STS. Several studies using the Bone and Soft Tissue Tumor Registry in Japan, supported by the JOA and National Cancer Center, have been started.


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