Eribulin in the soft tissue sarcoma therapeutic landscape: little is good, then more is better

Soft tissue sarcomas (STS) are a rare and heterogeneous group of mesenchymal tumors accounting for approximately 1% of adult solid malignancies (1). Chemotherapy remains the mainstay of treatment for patient with metastatic STS. Molecular-targeted therapies are active in selected and very rare histological subtypes such as crizotinib in ALK-rearranged inflammatory myofibroblastic tumor (2). To our knowledge, PD(L)1 inhibitors seem not to have significant activity in STS, but it is too early to conclude (3). Up to now second line treatment options (dacarbazine, ifosfamide, gemcitabine-docetaxel, trabectedin and pazopanib) were based on the results of phase II/III studies in which overall survival (OS) is not the primary endpoint or without significant improvement in OS (4-7). Recently, Patrick Schöffski and colleagues reported in a randomised multicentre phase III trial that treating advanced liposarcoma (LPS) and leiomyosarcoma (LMS) with eribulin an improvement in OS compared with dacarbazine (8).