Systemic therapy in NF-1 associated malignant peripheral nerve sheath tumors (MPNST).

person Pujita Munnangi Texas A&M School of Engineering Medicine, Houston, TX info_outline Pujita Munnangi, Bridgette L King, Y. Sabrina Chiang, Anthony Paul Conley, Dejka M. Araujo, J. Andrew Livingston, Joseph Aloysius Ludwig, Michael Nakazawa, Elise F Nassif Haddad, Vinod Ravi, Ravin Ratan, Maria Alejandra Zarzour, Shreyaskumar Patel, Keila E Torres, Neeta Somaiah

Authors person Pujita Munnangi Texas A&M School of Engineering Medicine, Houston, TX info_outline Pujita Munnangi, Bridgette L King, Y. Sabrina Chiang, Anthony Paul Conley, Dejka M. Araujo, J. Andrew Livingston, Joseph Aloysius Ludwig, Michael Nakazawa, Elise F Nassif Haddad, Vinod Ravi, Ravin Ratan, Maria Alejandra Zarzour, Shreyaskumar Patel, Keila E Torres, Neeta Somaiah Organizations Texas A&M School of Engineering Medicine, Houston, TX, The University of Texas MD Anderson Cancer Center, Houston, TX, Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, The University of Texas MD Anderson Cancer Center Hematology/Oncology Fellowship, Houston, TX, Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX Abstract Disclosures Research Funding No funding sources reported Background: MPNST are rare sarcomas that have a poor prognosis and are challenging to treat. Around 50% of MPNSTs are associated with NF1, 40% are sporadic, and 10% are radiation-associated. Doxorubicin (D) based chemotherapy (CT) regimens are commonly used in the front-line, and combinations have better response rates than single agents. Response to second-line regimens is not well documented. The objective of this study is to document efficacy of systemic regimens in MPNST as a benchmark for future novel therapeutics in this space. Methods: 72 patients (pts) with NF1-associated MPNSTs in an MD Anderson database were reviewed retrospectively from EMR. Variables collected included demographics, primary MPNST location, localized vs metastatic, and treatments received (+/- radiation, +/-surgery, +/- lines of CT). Responses (progressive disease (PD), stable disease (SD), partial response (PR)) as interpreted by treating physician and radiology reports and time on treatment for 1st and 2nd line chemotherapy regimens were assessed. Cox proportional-hazard regression was used to investigate associations of variables with overall survival (OS: from time of diagnosis to death or last follow-up). Results: Demographic and CT details are provided (Table). The median age at diagnosis was 34.5 yrs (range: 9-71). The most common MPNST location was the trunk (56.94%). D based regimens were the most frequent 1st-line CT (65.7%), and gemcitabine- docetaxel was the most frequent 2nd-line CT (33.3%). In pts with metastases, 74.4% got 1st line, 44.7% 2nd line, 25.5% 3rd line, and 12.7% got 4th line therapy. Median follow-up was 2.46 yrs (IQR 1.24-9.52). The median time on treatment for 1st and 2nd line CT was 110 (IQR 48-153) and 57 (IQR 41-133) days, respectively. In the multivariate COX model for the entire cohort, male sex (HR: 0.35, 95%CI: 0.18-0.68), lower extremity primary (HR: 0.09, 95%CI: 0.02-0.40), and absence of metastases at last follow up (HR: 0.05, 95%CI: 0.02-0.17) were associated with decreased risk of death. Additional analysis on efficacy and survival of the systemic therapy regimens will be presented at the meeting. Conclusions: In this study < 50% pts with advanced NF1 related MPNST made it to 2nd line CT and outcomes were inferior to the predominantly D based 1st line regimens. This highlights an area of high unmet need. Total n = 72 % of Total Sex Male Female 38 34 52.78 47.22 Primary Cervical Lower Extremity Trunk Upper Extremity Head & Neck 6 12 41 9 4 8.33 16.67 56.94 12.5 5.56 Metastasis At diagnosis Subsequent None 3 44 25 4.2 61.1 34.7 Neoadjuvant CT Y N 15 57 20.83 79.17 Radiation Y N Surgery Y N 45 27 57 15 62.5 37.5 79.2 20.8 1st Line CT (n = 35) D based* No D** 23 12 65.7 34.3 Response in 1st Line (n=35) PR SD PD 2 20 13 5.7 57.1 37.1 2nd Line CT (n = 21) D based* No D** 5 16 23.8 76.2 Response in 2nd Line (n=21) PR SD PD 1 9 11 4.8 42.9 52.4 D based: D/ D+ Ifos/VDC/ D+DTIC/ VDC-IE No D: Gem-Doce/IE/Carbo/Rapamycin/Tipifarnib-sorafenib/bevacizumab.