Neoadjuvant Imatinib in Advanced Primary or Locally Recurrent Dermatofibrosarcoma Protuberans: A Multicenter Phase II DeCOG Trial with Long-term Follow-up

• Published in: Clinical cancer research Vol. 20; no. 2; pp. 499 - 510
• Main Authors: UGUREL, Selma, MENTZEL, Thomas, KELLNER, Ivonne, LEVERKUS, Martin, BECKER, Jürgen C, STRÖBEL, Philip, SCHADENDORF, Dirk, UTIKAL, Jochen, HELMBOLD, Peter, MOHR, Peter, PFÖHLER, Claudia, SCHILLER, Meinhard, HAUSCHILD, Axel, HEIN, Rüdiger, KÄMPGEN, Eckhardt
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA American Association for Cancer Research 15.01.2014
• Subjects: Adult; Aged; Antineoplastic agents; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Benzamides - administration & dosage; Benzamides - therapeutic use; Biological and medical sciences; Biomarkers; Dermatofibrosarcoma - diagnosis; Dermatofibrosarcoma - drug therapy; Dermatofibrosarcoma - genetics; Dermatofibrosarcoma - pathology; Dermatology; Female; Fluorodeoxyglucose F18; Follow-Up Studies; Humans; Imatinib Mesylate; Male; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoadjuvant Therapy; Oncogene Proteins, Fusion - genetics; Pharmacology. Drug treatments; Piperazines - administration & dosage; Piperazines - therapeutic use; Positron-Emission Tomography; Protein Kinase Inhibitors - administration & dosage; Protein Kinase Inhibitors - adverse effects; Protein Kinase Inhibitors - therapeutic use; Pyrimidines - administration & dosage; Pyrimidines - therapeutic use; Treatment Outcome; Tumors; Tumors of the skin and soft tissue. Premalignant lesions; Antineoplastic agent; Human; Skin disease; Imatinib; Relapse; Sarcoma; Enzyme; Tyrosine kinase inhibitor; Toxicity; Transferases; Multicenter study; Enzyme inhibitor; Malignant tumor; Long term; Neoadjuvant treatment; Follow up study; Phase II trial; Primary; Advanced stage; Dermatofibrosarcoma protuberans; Protein-tyrosine kinase; Cancer
• ISSN: 1078-0432; 1557-3265
• DOI: 10.1158/1078-0432.CCR-13-1411

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. 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. 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. 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.