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Malignant phyllodes tumors of the breast occur infrequently and are difficult to treat with chemotherapy. Here, we present an effective chemotherapy strategy for recurrent malignant breast phyllodes tumors. A 48-year-old woman was diagnosed with a malignant phyllodes tumor in her right breast and underwent total right mastectomy. One year later, the tumor recurred in the right (a 2.2 cm mass) and left (a 10 cm mass) lungs; pleural effusion was also observed in the left lung. Eight courses of doxorubicin-ifosfamide (AI) therapy were administered. After treatment, the right lung mass and pleural effusion regressed completely and the left lung mass regressed to 2 cm. In conclusion, AI therapy is useful for treating recurrent malignant breast phyllodes tumors.

The increasing complexity of cancer chemotherapy now requires that pharmacists be familiar with these highly toxic agents. This column will review various issues related to preparation, dispensing, and administration of cancer chemotherapy, and review various agents, both commercially available and investigational, used to treat malignant diseases. The views expressed in this article are those of the author(s) and do not reflect the official policy of the Department of Army, Department of Defense, or US Government.

Background. Doxorubicin/ifosfamide is a first-line systemic chemotherapy for the majority of advanced soft tissue sarcoma (ASTS) subtypes. Trabectedin is indicated for the treatment of ASTS after failure of anthracyclines and/or ifosfamide; however it is being increasingly used off-label as a first-line treatment. This study estimated the cost effectiveness of these two treatments in the first-line management of ASTS in Italy, Spain, and Sweden.Methods. A Markov model was constructed to estimate the cost effectiveness of doxorubicin/ifosfamide compared to trabectedin monotherapy, defined as the cost per QALY gained, in each country.Results. First-line treatment with doxorubicin/ifosfamide resulted in lower two-year healthcare costs and more QALYs than first-line treatment with trabectedin monotherapy in all three countries. Probabilistic sensitivity analysis showed that at a cost per QALY threshold of €35,000, >90% of a cohort would be cost effectively treated with doxorubicin/ifosfamide compared to trabectedin monotherapy in all three countries.Conclusion. Within the model’s limitations, first-line treatment of patients with ASTS with doxorubicin/ifosfamide instead of trabectedin monotherapy affords a cost-effective use of publicly funded healthcare resources in Italy, Spain, and Sweden and is therefore the preferred treatment in all three countries. These findings support the recommendation that trabectedin should remain a second-line treatment.

Background: The combination of doxorubicin/ifosfamide is an effective chemotherapy regimen in metastatic soft-tissue sarcomas (STS), generally resulting in remission rates between 30 and 40%. A seriou

e15523 Background: Metastatic or recurrent uterine leiomyosarcoma is often treated with chemotherapy. There are a limited number of viable regimens that are effective and well tolerated. Our objective was to evaluate the efficacy and toxicity of the MAID chemotherapy regimen in women with advanced uterine leiomyosarcoma. Methods: We conducted a retrospective analysis of 18 patients who received MAID chemotherapy for metastatic or recurrent uterine leiomyosarcoma between 1998 and 2010. Ten patients had received prior radiation therapy (3) and/or gemcitabine-docetaxel chemotherapy (8). The MAID regimen was administered intravenously in the hospital every three weeks as follows: mesna 120 mg/m2 prior to ifosfamide day 1 and 1.2 mg/m2 infusion over 8 hours starting immediately after the ifosfamide d 1-3, doxorubicin 15 mg/m2 d 1-3, ifosfamide 1.2 gm/m2 d 1-3, and dacarbazine 200 mg/m2 d 1-3. Disease response was evaluated by physical exam and imaging studies. Toxicity was assessed using NCI Common Toxicity Criteria. Results: Response to MAID chemotherapy was observed in 7 (39%) of 18 patients: 2 (11%) complete responses and 5 (28%) partial responses. Stable disease was noted in 8 patients (44%) and disease progression occurred in 3 patients (17%). There was no difference in response rates between patients who had received prior chemotherapy (3/8, 38%) and patients who had not received prior chemotherapy (4/10, 40%). A total of 90 cycles of chemotherapy were administered with a median of 5.5 (range 1-9) cycles per patient. Grades 3 and 4 toxicity requiring dose reduction of treatment delay complicated only 4 cycles (4.4%), including only one admission for neutropenic fever. There were no reported cases of cardiac dysfunction, hemorrhagic cystitis, or encephalopathy. The median progression-free survival was 10 (range 6-152) months for responders, 7.5 (range 3-120) months for those with stable disease, and 0 months for those with progressive disease. Conclusions: This is the largest series of uterine leiomyosarcoma patients treated with MAID chemotherapy. MAID chemotherapy in the dosage schedule utilized is a well-tolerated and effective regimen.