Neoadjuvant imatinib in advanced primary or locally recurrent dermatofibrosarcoma protuberans: a multicenter phase II DeCOG trial with long-term follow-up.

Abstract

PURPOSE:

Dermatofibrosarcoma protuberans (DFSP) is a rare cutaneous tumor. COL1A1-PDGFB gene fusion is frequent in DFSP, rendering tumor cell proliferation and survival dependent on PDGFRβ (platelet-derived growth factor receptor β) signaling. This trial investigated imatinib as neoadjuvant treatment of DFSP, including long-term follow-up.

EXPERIMENTAL DESIGN:

The primary endpoint of this multicenter phase II trial was response; secondary endpoints were safety, tumor relapse, and response biomarkers. Patients with advanced primary or locally recurrent DFSP and measurable disease by RECIST (response evaluation criteria in solid tumors) were eligible and received imatinib 600 mg/d until definitive surgery with histopathologic proof of tumor-free margins.

RESULTS:

Sixteen patients received imatinib, and 14 patients were evaluable for all endpoints. Median treatment duration was 3.1 months; median tumor shrinkage was 31.5%. Best overall response was 7.1% complete response (CR), 50.0% partial response (PR), 35.7% stable disease, and 7.1% progressive disease (PD). Toxicity was moderate with 25.0% grade 3 and 4 events. During a median follow-up of 6.4 years, one patient developed secondary resistance to imatinib but responded to second-line sunitinib. This patient also presented local recurrence, distant metastasis, and death from DFSP. Exploratory analysis showed that response to imatinib was associated with decreased tumor cellularity and formation of strong hyalinic fibrosis. Weak PDGFRB phosphorylation and pigmented-type DFSP were associated with nonresponse. Additional to PDGFRB, the kinases EGFR and insulin receptor were found activated in a high percentage of DFSPs.

CONCLUSION:

The neoadjuvant use of imatinib 600 mg/d in DFSP is efficacious and well tolerated. Long-term follow-up results do not definitely support smaller surgical margins after successful imatinib pretreatment, and presume that secondary resistance to imatinib might promote accelerated disease progression.

• Authors: Selma Ugurel, Thomas Mentzel, Jochen Utikal, Peter Helmbold, Peter Mohr, Claudia Pföhler, Meinhard Schiller, Axel Hauschild, Rüdiger Hein, Eckhardt Kämpgen, Ivonne Kellner, Martin Leverkus, Jürgen C Becker, Philip Ströbel, Dirk Schadendorf
• Journal: Clinical cancer research : an official journal of the American Association for Cancer Research (Clin Cancer Res) Vol. 20 Issue 2 Pg. 499-510 (Jan 15 2014) ISSN: 1557-3265 [Electronic] United States
• PMID: 24173542 (Publication Type: Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: ©2013 AACR.

Chemical References

• Antineoplastic Agents
• Benzamides
• Biomarkers
• COLIA1-PDGFB fusion protein, human
• Oncogene Proteins, Fusion
• Piperazines
• Protein Kinase Inhibitors
• Pyrimidines
• Fluorodeoxyglucose F18
• Imatinib Mesylate

Topics

• Adult
• Aged
• Antineoplastic Agents (administration & dosage, adverse effects, therapeutic use)
• Benzamides (administration & dosage, therapeutic use)
• Biomarkers
• Dermatofibrosarcoma (diagnosis, drug therapy, genetics, pathology)
• Female
• Fluorodeoxyglucose F18
• Follow-Up Studies
• Humans
• Imatinib Mesylate
• Male
• Middle Aged
• Neoadjuvant Therapy
• Oncogene Proteins, Fusion (genetics)
• Piperazines (administration & dosage, therapeutic use)
• Positron-Emission Tomography
• Protein Kinase Inhibitors (administration & dosage, adverse effects, therapeutic use)
• Pyrimidines (administration & dosage, therapeutic use)
• Treatment Outcome