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The Desmoid Tumor Research Foundation

January 2020

Familial adenomatosis polyposis-related desmoid tumours treated with low-dose chemotherapy: results from an international, multi-institutional, retrospective analysis

Author Information

Napolitano A(1), Provenzano S(2), Colombo C(3), Vitellaro M(3), Brunello A(4), Badalamenti G(5), Nannini M(6), Ibrahim T(7), Hohenberger P(8), Gasperoni S(9), Gennatas S(10), Jones RL(10), Hindi N(11), Martin-Broto J(11), Spalato Ceruso M(1), Silletta M(1), Dei Tos AP(12), Gronchi A(3), Stacchiotti S(2), Santini D(1), Tonini G(1), Palassini E(2), Vincenzi B(13).

(1)Medical Oncology, Universita Campus Bio-Medico di Roma, Roma, Lazio, Italy. (2)Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy. (3)Department of Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Lombardia, Italy. (4)Medical Oncology, IOV IRCCS, Padova, Veneto, Italy. (5)Medical Oncology, Paolo Giaccone Policlinic, Palermo, Sicilia, Italy. (6)University of Bologna Hospital of Bologna Sant'Orsola-Malpighi Polyclinic, Bologna, Emilia-Romagna, Italy. (7)Surgical Oncology and Thoracic Surgery, Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori Srl, Meldola, Emilia-Romagna, Italy. (8)Medical Oncology, Faculty of Medicine, Ruprecht Karls University Heidelberg, Mannheim, Baden-Wrttemberg, Germany. (9)Sarcoma Unit, University Hospital Careggi, Firenze, Toscana, Italy. (10)Medical Oncology, Royal Marsden NHS Foundation Trust, London, London, UK. (11)Anatomic Pathology, Institute of Biomedicine of Seville (IBiS), Sevilla, Spain. (12)Treviso General Hospital, Treviso, Italy. (13)Medical Oncology, Universita Campus Bio-Medico di Roma, Roma, Lazio, Italy.

Publication

ESMO Open

Summary

Desmoid tumour (DT) is a locally aggressive fibroblastic proliferative disease representing the most common extraintestinal manifestation of familial adenomatosis polyposis (FAP). As data on the activity of chemotherapy in these patients are limited, we examined the outcomes of patients treated with low-dose methotrexate (MTX) +vinca alkaloids (vinorelbine or vinblastine). We retrospectively reviewed clinical and outcome data from all patients with confirmed FAP-associated DTs treated with weekly MTX+vinca alkaloids in seven European sarcoma reference centres between January 2000 and December 2018. We identified 37 patients (median age 29 years, range 7-44). According to RECIST, 20/37 (54.1%) patients achieved partial response (PR), 15/37 (40.5%) patients had stable disease and 2/37 (5.4%) had progressive disease as best response. Overall, the median progression-free survival (PFS) was 6.5 years (range, 0.3-12.1 years). In the subset of patients achieving PR as best response, the median PFS was not reached. In a subset of 11 patients with progressive disease offered MTX+vinca alkaloids rechallenge (after chemotherapy withdrawal following prolonged disease control), the disease control rate was 100%, resulting in a median PFS after rechallenge of 5.8 years.This is the largest series on the activity of low-dose chemotherapy in patients with FAP-related DT. In this population, MTX+vinca alkaloids is an active combination, as already reported in patients with sporadic DT.

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