Ewing's Sarcoma: Refractory and Recurrent Disease
Refractory Ewing's Sarcoma
Sometimes, the biopsy of the resected tumor shows little necrosis (i.e., a low percentage of the cancer cells are dead). If this occurs, or if the tumor continues to grow while the patient is receiving chemotherapy, the term refractory is frequently used. Sometimes, the term is also used when micrometastases (micromets) develop. Micromets are very small mets. Ewing's sarcoma is considered a systemic cancer. A patient may very well have micromets when diagnosed. The treatment may or may not kill them.
Recurrent Ewing's Sarcoma
If tumors come back in either the primary site or in a new site (i.e., the cancer has metastasized) once the treatment is done, the patient has recurrent Ewing's sarcoma. This event is also called a relapse.
If Ewing's sarcoma metastasizes, it normally spreads to the lungs, bones and bone marrow. Clinical trials haven't really distinguished between treating recurrent and refractory cases.
Treatment for Recurrent/Refractory Tumors
(in no particular order)
Topotecan and Cyclophosphamide
High-dose Ifosfamide
- 1989 abstract discussing high-dose ifosfamide; 5/8 responses in recurrent Ewing's sarcoma.
- 2001 abstract presenting a case study Ewing's sarcoma being treated with high-dose ifosfamide; perhaps the dose was too high.
- 2002 abstract discussing 4/10 response for soft tissue sarcoma with high-dose ifosfamide; paper is in Chinese
Ifosfamide, Carboplatin, and Etoposide
-
1995 abstract discussing the ICE protocol; good results with soft tissues sarcomas
Other Possible Drugs for Refractory/Recurrent Ewing's Sarcoma
- Carboplatin
- Cisplatin (a.k.a. Plantinol)
- Docetaxel/Taxotere
- Gemcitabine and Docetaxel
- Exatecan
- Irinotecan
- Irinotecan and Temozolomide
Related Links
- Treatments currently in clinical trials
- Barry Sugarman's web page on treatments for relapse Ewing's Sarcoma
- Stem cell rescue
- A number of trials have been performed on chemo agents not listed above; some are considered not successful enough to be considered as a reasonable approach; some of these are discussed here.
Related Papers
-
2003 abstract discussing local recurrences for soft tissue sarcomas; states that local recurrences need aggressive treatment