The CancerWeb Report, What's New In Cancer: October, 1996
Soft Tissue Sarcomas

• Combination of tumor necrosis factor (TNF), interferon and melphalan helps achieve effective surgery - Soft tissue sarcomas account for about 1% of all cancers, and more than half of them occur in the limbs. Tumors are often very large when diagnosed, and it is frequently not possible to remove them surgically while still preserving limb function. A multicenter European study used an initial subcutaneous injection of interferon gamma followed by a combination of the biological agents tumor necrosis factor alpha and interferon gamma with the chemotherapy drug melphalan, given by isolated limb perfusion, to help shrink these limb tumors to operable size; 3 patients needed more than one perfusion. Tumor remnants were surgically removed between 4 and 24 weeks after isolated perfusion. The results, published in the October, 1996 issue of the Journal of Clinical Oncology indicated that of 55 patients, 36% had complete and 51% had partial responses, as determined after histologic examination of the tumor remnant that was removed. Limb salvage was achieved in 46 patients, and amputations were necessary in 9. There were 13% local recurrences at 2.5 years and 44% metastases (16% of patients had metastatic disease before being treated). Local toxicity consisted of 7 temporary and 4 long-term/permanent cases of loss of (or abnormal) sensation in the perfused limbs, and all patients developed fever and chills; other side-effects (lowered blood pressure, gastrointestinal upset, hematologic side-effects, and cardiac changes) were moderate and manageable. (Eggermont, J Clin Oncol 14:2653, 1996)