Studies Show Promise for Treatment Advances in Several Types of Sarcoma

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Sarcoma, a type of cancer that can affect the bones or the body’s soft tissues — such as muscle, fat, and tendons — is often curable with surgery. But for those tumors that cannot be surgically removed or that come back after surgery, there have been few treatment options. This is in large part because sarcomas usually do not respond to traditional chemotherapy.

Targeted therapies, which work by taking advantage of genetic alterations in tumor cells, hold promise for bringing sarcomas under control. Now two trials of experimental drugs are showing encouraging results in treating certain subtypes of sarcoma.

A Diverse Group of Tumors

“Historically, the challenge of treating sarcoma has been that it’s a very complex group of different diseases,” says Memorial Sloan Kettering medical oncologist and sarcoma expert Mark A. Dickson. “Sarcoma is not one cancer, but more than 50 different subtypes. Trials that have tried to give the same drug for all sarcomas have not been successful.”

To develop targeted therapies, investigators need to determine the molecular changes that cause the disease in each of the different subtypes. Memorial Sloan Kettering is a leader in that effort, with a database that combines our collection of tumor samples from patients with information about those patients, such as age at diagnosis and details about their tumors and treatments.

“Our research is focused on looking for genes that are either mutated or amplified,” says Gary K. Schwartz, Chief of Memorial Sloan Kettering’s Melanoma and Sarcoma Service. “If a gene is amplified and makes many more copies than it should, it can often be a driver for cancer.”

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Targeting Liposarcoma

A recent phase II trial led by Dr. Dickson focused on one of the most common types of sarcoma, called well-differentiated or de-differentiated liposarcoma, a more common type of sarcoma that originates in fat cells. The study was published online April 8 in the Journal of Clinical Oncology.

The trial was of a drug called PD0332991 (palbociclib), which targets a protein called CDK-4. That protein is overexpressed in this type of sarcoma because of a gene amplification and leads to the growth of cancerous cells. All patients in the trial had this particular molecular abnormality.

In the study, 30 patients received PD0332991 for 12 weeks. The investigators found that 70 percent of the patients did not have their disease progress during that time, which greatly exceeded the researchers’ expectations. In addition, some patients had significant shrinking of their tumors.

“As far as we know, this is the first time anyone has done a phase II trial for this subtype of sarcoma, and in that way it’s a pioneering study,” Dr. Dickson says. “Based on our results there has been a lot of interest from doctors around the country who want to get their patients on this drug, and we are expanding the trial so that we can treat more patients.”

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Testing Combination Therapies

Another trial, published in the April issue of Lancet Oncology, was led by Dr. Schwartz. In that study, also a phase II trial, investigators combined an experimental drug called cixutumumab with temsirolimus (Torisel®), a drug already approved for some forms of kidney cancer, to treat several subtypes of bone and soft tissue sarcoma.

Cixutumumab is an antibody that targets a receptor on cancer calls known as IGF-1R. Temsirolimus blocks a cancer-related pathway called mTOR. Both IGF-1R and mTOR are critical for the growth of many sarcoma types.

“You can think of mTOR as the engine of the cancer cell that’s responsible for its survival, and IGF-1R as the ignition,” Dr. Schwartz explains. “The idea is that you use cixutumumab to cap the ignition, so that the key can’t go in the lock. But you are also adding the extra benefit of inactivating the engine itself by using temsirolimus to block mTOR.”

“This is the first multicenter clinical study ever conducted to evaluate this combination,” Dr. Schwartz adds.

The multicenter trial, which included 388 patients, found that the number of patients whose disease did not progress after 12 weeks of treatment was improved compared with other treatments. In addition, some patients with a type of sarcoma called solitary fibrous tumor had stable disease for more than a year. Patients with the subtypes Ewing sarcoma, osteosarcoma, and chondrosarcoma had partial shrinkage of their tumors.

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Moving Forward with New Trials

Dr. Dickson and Dr. Schwartz plan to move their research forward with larger, phase III trials, but challenges remain. Dr. Schwartz notes that it is difficult to find funding from pharmaceutical companies to treat sarcomas, which are considered rare diseases. Recruiting enough patients to participate in a larger trial can also be a roadblock.

“For research on these rare cancers like sarcoma, which affects about 13,000 people per year, funding from organizations like Cycle for Survival is becoming increasingly important,” Dr. Schwartz says. “Money from Cycle for Survival funded much of this research, from the basic research in the laboratory up to and including this phase II trial.”

Both physicians have trials under way for other experimental sarcoma drugs and continue to focus on research looking for new targets.

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Dr. Dickson’s research was funded by a Career Development Award from the Conquer Cancer Foundation, Pfizer, and the National Cancer Institute under grant CA047179. Dr. Schwartz’s research was funded by Cycle for Survival and the National Cancer Institute under grants CA148260 and CA140331.

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Reebain, thank you for your question. If you live outside the United States and are interested in a consultation at Memorial Sloan Kettering, you should contact our International Center by calling 1-212-639-4900 or going to http://www.mskcc.org/cancer-care/international-patients). The email address is international@mskcc.org. They will be able to answer your questions.
Memorial Sloan Kettering does provide financial help to patients in need. If you do not have health insurance or are worried that your health insurance may not cover your hospital bill in full, we may be able to help. Go to this link to learn more:
http://www.mskcc.org/cancer-care/hospital-information/financial-assista…

I am a 54 year old female in very good health, just diagnosed with Follicular Dendritic Sarcoma. My left tonsil was enlarged and did not respond to antibiotics, had a tonsillectomy three weeks ago, local labs unable to diagnose biopsy, was sent to Johns-Hopkins where it was diagnosed last week as FDCS. None of the oncologists locally have dealt with treatment. I have heard MD Anderson has some experience and am hopeful MSKCC has as well. There is so little information available. Can you point me in some direction to get accurate info? I'm currently awaiting a PET scan appointment. Thank you.

Robbie, thank you for your comment. Our physicians have experience treating many rare forms of cancer, including sarcomas.

You can read more about treatment of sarcoma at Memorial Sloan Kettering here:

http://edit.mskcc.org/cancer-care/adult/soft-tissue-sarcoma

http://www.mskcc.org/blog/studies-show-promise-treatment-advances-sever…

If you would like to make an appointment with a Memorial Sloan Kettering physician, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment.

My sister was recently dx with synovial sarcoma in her R ulnar nerve. She is already a cancer survivor (Hodgkins 22 yrs ago)...She is now going through radiation and will follow with surgery. I was wondering if there are any trials and or info on synovial sarcomas of the nerves? Thanks. T

Tammy, thank you for reaching out. At this link is a listing of clinical trials for synovial sarcoma at Memorial Sloan Kettering (you can call the number listed in the trial description to learn about eligibility or whether it’s appropriate for her case):

http://www.mskcc.org/cancer-care/adult/soft-tissue-sarcoma/clinical-tri…

You can also see a full listing of synovial sarcoma clinical trials by the National Cancer Institute at this link:

https://clinicaltrials.gov/ct2/results?term=%22synovial+sarcoma%22&Sear…

To learn more about how Memorial Sloan Kettering treats soft tissue sarcomas, include synovial sarcoma, you can go to http://www.mskcc.org/cancer-care/adult/soft-tissue-sarcoma. If your sister would like to speak to someone at Memorial Sloan-Kettering about receiving a second opinion or coming here for treatment, you can call 800-525-2225 or go tohttp://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

I was diagnosed in 2004 at age 46 with a low grade pelvic leiomyosarcoma. It was resected with no further treatment. It recurred within 5 months and was resected again with 35 external radiation treatments. 8 years later, earlier this year, it recurred again. Adriamycin was administered which had no effect on the tumor. It was resected but due to surgical complications intraoperative radiation was not given, however this time it is being described as a liposarcoma. A second opinion was sought at another facility who describes it as a leiomyosarcoma. The second facility is recommending Gem Tax . A third facility is recommending Votrient. I am not sure how to proceed as it seems that several reputable facilities cannot agree on either what type of tumor I have or what treatment I should take.

Dear Lora, this sounds like a very difficult situation. The first step is to get the most-accurate diagnosis possible. Unfortunately, we can’t give personal medical advice on our blog beyond this. If you would like to consider making an appointment with one of our doctors, then please do call 800-525-2225 during regular business hours to learn more. Or to begin the process online you can go here: http://www.mskcc.org/cancer-care/appointment. If coming to us is not a possibility, it might be possible for one of your doctors to request a pathology consultation to confirm or refine the diagnosis: http://www.mskcc.org/cancer-care/pathology-consultations. Here is some more information you might find helpful on how we diagnose and treat the disease: http://www.mskcc.org/cancer-care/adult/soft-tissue-sarcoma/diagnosis-tr….

I would like to know of any research or study ongoing on leiomyosarcoma caused by radiation exposure. If so, directions on how to access such information and the progress of the study. Thank you.

Dear Francis, if you would like information about research into the causes of leiomyosarcoma, we recommend that you reach out to the National Cancer Institute’s Cancer Information Service at 800-4CANCER. If you or someone you know has been diagnosed with leiomyosarcoma and would like to speak to a doctor at MSK about treatment options, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My niece has been diagnosed with spindle cell sarcoma. She lives near Detroit and is going to the Michigan University sarcoma unit. I was hoping that you could give some idea as to the quality of the care there. Also, I was wondering if you might be able to recommend a specific doctor with expertise in this sarcoma whom you would recommend that she contact. I realize that you may not want to offer any response to those questions, but I cannot be for sure unless I ask. I am going to suggest that she contact your organization as well. It sounds like you folks may be one of the best in this specific area.
Thank you for your time and information.
Bruce Benoy

Dear Bruce,w e are sorry to hear about your niece. We suggest you call our Physician Referral Service at 800-525-2225. Our knowledgeable staff may be able to get some of these questions answered and can also make an appointment for a second opinion if your niece is interested in consulting with one of our sarcoma specialists. You may also be interested to know that two National Cancer Institute-designated comprehensive cancer centers in Michigan: The Barbara Ann Karmanos Cancer Institute at Wayne State University School of Medicine in Detroit, and the University of Michigan Comprehensive Cancer Center in Ann Arbor. She may think about contacting them for a consultation as well. We hope this is helpful. Thank for reaching out to us.

My Ball bladder was removed Dec,24 and the diagnosis I just received from Johns Hopkins is: Gallbladder High Grade Angiosarcoma involving the gallbladder CD31+, ERG+
Liver High Grade Angiosarcoma , CAM 5.2+
What is the best Cancer center for me to immediately go to? I do have an appointment at the Abramson Cancer Center at Penn Medicine.

Helfried, thank you for reaching out. Memorial Sloan Kettering physicians have a great deal of expertise in treating all types of sarcoma. You can learn more at this link:

http://www.mskcc.org/cancer-care/adult/soft-tissue-sarcoma

If you would like to make an appointment, please call our Physician Referral Service at 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment. Thanks for your comment.

I have just been diagnosed by Johns Hopkins, after my Gallbladder operation that:Gallbladder is High Grade Angiosarcoma CD31+ ERG+
Liver High Grade Angiosarcoma CAM 5.2+
I have an appointment at Penn Medicine Abramson Cancer Center Phil on Jan. 27. Should I consider an appointment if at all possible at Sloan Kettering? Can anyone help me to live?

Helfried, please see our reply above this to your previous comment—you can call our Physician Referral Service at 800-525-2225 to inquire about an appointment or second opinion. Thank you for your comment.

I am looking for information about "Epithelioid neoplasm with features compatible with malignant PEComa in right posterior calf" and did your center have seen any patients. being told as rarest of the rare type.

Dear sir
Reading on your website has given me lots of hope. My family lives in Savannah Ga, my son has had recurrent osteosarcoma since 2010. His last surgery was 1 month ago and all margins were clear. Each time his margins were clear but he goes on to have recurrence. His oncologist proposes a three drug combination of gemcitabine , ABRAXANE and AVASTIN for 6 cycles. My question is what has been the efficacy of this regimen. Seems like a pretty good combination but has no info as to its efficacy. I would be really if you can help me and my son, thanks in advance

William, we are not able to offer advice about particular treatment protocols on our blog. If you’d like to make an appointment for a consultation with one of our osteosarcoma experts, you can call 800-525-2225 or go to http://www.mskcc.org/cancer-care/appointment for more information. Thank you for your comment.

My husband has been a patient at MD Anderson Houston for the last few years with liposarcoma. He did hard core chemo, radiation and then surgery. It came back in less than a year. Now the chemo has stopped working. MD Anderson doesn't know what to do now. If one of the best in the nation is at a loss, what are we to do? I cannot give up on him. It isn't in his lymphnodes and hasn't spread throughout his body. The tumors are just getting bigger very quickly. Feeling helpless for him and my girls.

my husband was diagnosed with a pleomorphic spindle cell sarcoma in his arm in Dec 2014. He underwent surgery, it was removed and his lungs were clear at that time. 6 months later, during a routine CT scan, tumors in both lungs were discovered. We have an appt at MD Anderson in June. Are there any recommendations for cancer of this type?

Unfortunately we cannot offer specific treatment recommendations on our blog. If your husband would like to make an appointment with one of our specialists for a second opinion to discuss his treatment options, please call our Physician Referral Service at 800-525-2225. You may also find additional information about this type of cancer, treatments, and clinical trials on the National Cancer Institute’s website at www.cancer.gov. We hope this is helpful and wish your husband our best as he makes decisions around treatment.

My brother was just diagnosed at the Cleveland Clinic with Stage 2 Chondrosarcoma in the cartilage in his right shoulder. Five years ago he was diagnosed with Parkinson's which presented itself as tremors in the right arm. He is scheduled for cancer surgery within the next 7 days. How long would it take to get a 2nd opinion with an expert in this type of cancer? Do you ever give a 2nd opinion on FaceTime? My brother is 60 with full insurance that he pays for. He loves his doctor and team at the CC, but our concern is the number of Chrondrosarcoma surgeries performed there compared to MSK, MD Anderson, UCLA, etc. With this type of cancer, it seems it's all about the surgeon and team of oncologists' experience and expertise since radiation and chemo aren't part of the treatment plan. Any advise would be greatly appreciated. Thank you!

Thanks so much for reaching out to us about your brother’s diagnosis. As you mention, we have a whole team of experts highly experienced in not only treating these cancers but helping people preserve their quality of life after treatment. Our recommendation is that you give us a call at 212-639-6219. This is a more direct number for our bone cancer patients, and should hopefully speed the process of getting your brother a second opinion. (The line opens Monday at 8:30 am Eastern time.) We’ll forward your message on as well, but please do give them a call. Thank you again, and we’re wishing you and your brother all the best.

I am looking for information about “high-grade undifferentiated pleomorphic sarcoma of the liver” and if there have been any patients (after resection of the tumor) successfully treated in your center?

Our experts see people with all types of cancer, including those with the rarest forms of the disease. You may be interested in learning more about this particular type of cancer by visiting the National Cancer Institute’s website: http://www.cancer.gov/types/soft-tissue-sarcoma/hp/child-soft-tissue-tr…

If you are interested in making an appointment for a consultation with one of our specialists, please call our Physician Referral Service at 800-225-2225. Thank you for your comment.

Hi... I am a 46 years old woman diagnosed with leiomyosarcoma. I don't have medical insurance in the United States as well I can't afford paying as international patients. Is there any way I can still get treatment from Sloan Kettering please? Appreciate your help.

Reebain, thank you for reaching out. If you live outside the United States and are interested in a consultation at Memorial Sloan Kettering, you should contact our International Center by calling 1-212-639-4900 or going to http://www.mskcc.org/cancer-care/international-patients). The email address is international@mskcc.org. They will be able to answer your questions.
Memorial Sloan Kettering does provide financial help to patients in need. If you do not have health insurance or are worried that your health insurance may not cover your hospital bill in full, we may be able to help. Go to this link to learn more:
http://www.mskcc.org/cancer-care/hospital-information/financial-assista…

Yes I'm trying to find out about the possible causes of spindle cell tumours.last August I had a very large spindle cell tumour and prostate removed. Industrial chemicals popped up A few times and I'm trying to find a list of those chemicals wondering if you have any idea if there is an actual list of chemicals?

Thanks so much for reaching out to us. Our recommendation is that you contact the National Cancer Institute to see if such a list exists. You can call them at 1-800-4-CANCER or you can choose the live chat option from the toolbar at the top if you go to www.cancer.gov.

A friend of mine is in the advanced stages of Spindle Cell Sarcoma. We are searching for someone who would see her and discuss possible options. If you have any suggestions, they would be greatly appreciated.

I am writing on behalf of my husband who has spindle cell sarcoma with pleomorphic sarcoma which has metasized to the lungs. I was looking at immunotherapy drugs like opdivo. Are there any options for him which might extend his life? They have given him a year to 18 months. We have two small children.

We’re sorry to hear about your husband’s diagnosis. For a list of current clinical trials at MSK for sarcoma, you can go to https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/clinical-tr…. If you’d like to make an appointment, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information. If you are not able to come to MSK, we recommend you go to www.clinicaltrials.gov and look for research in your area. Thank you for your comment.

I have recently been diagnosis with a spindle cell tumor. Please could you explain it. I have tried to research it but not finding much information.

Dee, we’re very sorry to hear about your diagnosis. Spindle cell tumor, also called malignant fibrous histiocytoma, is a rare type of sarcoma that usually occurs in children and young adults. If you’d like to learn more, we recommend you visit the National Cancer Institute’s web page on this disease: http://www.cancer.gov/types/bone/patient/osteosarcoma-treatment-pdq. If you’d like to make an appointment for a consultation at MSK, you can call 800-525-2225 or go to https://www.mskcc.org/experience/become-patient/appointment for more information on making an appointment. Thank you for your comment.

I m male 47 and found with synovial sarcoma in my left lung lobe lower part 5.5cm and sarcoma dept of MD Anderson is suggesting Chemotherapy for 18 weeks ( 6 round of 21 days) and then do surgery after tumar shrink, do you have any other immunocherapy or clinical trial ? and what are the side effects of above round of chemo therapy with Ifosfamide for 5 days and Doxorubicin, Mesna with Vincristine option in a 21 cycle

Mike, thank you for reaching out. Memorial Sloan Kettering does have a clinical trial for synovial sarcoma that has spread to the lung. You can find out more information here:

https://www.mskcc.org/cancer-care/clinical-trials/14-075

There also will be more information available on www.clinicaltrials.gov, where trials from all over the world are listed.

Regarding side effects of the regimen you mention, we suggest you consult with your treatment team.

If you would like to make an appointment with a Memorial Sloan physician for a consultation about possible treatments, please call our Physician Referral Service at
800-525-2225 or go to http://www.mskcc.org/cancer­care/appointment.

You also can read more about the treatment of sarcoma at Memorial Sloan Kettering here:

http://edit.mskcc.org/cancer-care/adult/soft-tissue-sarcoma

https://www.mskcc.org/blog/studies-show-promise-treatment-advances-seve…

My 19-year-old son was diagnosed with metastatic osteosarcoma in August 2015 he has undergone nine chemotherapy treatments with cisplatin doxorubicin and methotrexate. We feel very confident with the medical team at Phoenix Children's Hospital, although are seeking as much information as possible for our son and his survival . They successfully removed the tumor in his femur and all of the edges were clear. We're now getting ready to tackle his lung metastasis . He will be having surgeries on both longs to have tumor's hand removed by a pediatric thorasic surgeon. I am interested in finding out about some treatments that are In the trial phase. I have read several things that Sloan Kettering is working on some treatments with cisplatin being in hailed into the lungs to help Prevent the tumors from coming back . Any information on this would be greatly appreciated or number of who I can contact and talk to. Thank you so much for your time . Sara Jones

Sara, thank you for reaching out. We are sorry to hear about your son’s diagnosis. Memorial Sloan Kettering does have a number of clinical trials for osteosarcoma. You can see the list here and read more on each one to learn about eligibility and contact info:

https://www.mskcc.org/cancer-care/clinical-trials/search?keys=osteosarc…

In addition, here is a list of osteosarcoma clinical trials on the government’s clinical trials website, some of which involve cisplatin:

https://clinicaltrials.gov/ct2/results?term=osteosarcoma+cisplatin&Sear…

If you are interested in coming to Memorial Sloan Kettering for a consultation, please call our Physician Referral Service at
800-525-2225 or go https://www.mskcc.org/experience/become-patient/appointment

What are the treatment options for stage 4 metastatic angiosarcoma?

Dear Emma, if you have sarcoma that has returned or spread, our doctors may recommend that you receive chemotherapy while continuing to evaluate whether surgery will help you. If the cancer doesn’t get better with chemotherapy, we may recommend you consider enrolling in a clinical trial testing new investigative treatments. For sarcomas that have spread to the brain and spine we sometimes recommend an approach called stereotactic radiosurgery in which we deliver extremely precise, very intense doses of radiation to eliminate tumors.

For a more-personalized assessment of your treatment options, we recommend you talk to your oncologist. If you are interested in the possibility of enrolling in one of our clinical trials, please call our Physician Referral Service at 800-525-2225 to make an appointment with one of our specialists. To learn more about our clinical trials for soft tissue sarcoma, please visit
https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/clinical-tr…

Thank you for reaching out to us.

I'm just curious why MSK is no further along in treating Hemangiopericytoma of the brain (soft tissue sarcoma/solitary fibrous tumors). I realize it’s very rare but because I believe MSK is NO longer on the cutting edge, nor thinking outside the box regarding new treatments and drugs even though commercials state otherwise, MSK should be further along in having something to control this terrible cancer especially being that a family member happily consented to letting MSK keep the tumor tissues for research over 10+ years ago. While I realize MSK deals with cancer and death every day I feel on some days and in certain cases, MSK has become immune to the needs and concerned of patients fighting a frightening disease no matter what type of cancer. Just because this is a rare cancer and not many people have it doesn't mean research, trials or drugs shouldn't be explored just like glioblastomas, ovarian cancers, etc. I sometimes think MSK takes a slower approach, would rather deal with cancers they think they can beat/control. While we are extremely blessed to have wonderful doctors at MSK, we like many other patients and caregivers at some point will be faced with life/health challenges. It’s now a guessing game on what needs to be done. I know cancer is big business but frankly I think human life is more important and research team and doctors should be looking at and exploring drugs for this cancer as well as other rare one. Thank you

Dear Elizabeth, we agree that rare cancers like soft tissue sarcoma need and deserve more attention and research. A great deal of research is actually being conducted on solitary fibrous tumors at present, but it remains a very difficult disease.

We are working hard to explore novel therapies - including targeted drugs and immunotherapy - in the lab and investigate their safety and effectiveness in clinical trials, which you can browse through here:

https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/clinical-tr…

In addition, we have received incredible support from Cycle for Survival, team cycling events held across the country to raise funds exclusively for our research into rare cancers (learn more at https://www.cycleforsurvival.org/).

We appreciate your comments and are happy to know that you and your loved ones have felt well-cared for by your MSK physicians.

My niece has stage IV soft tissue sarcoma that has metastasized to her lungs. She is being sent home today with hospice care. She does not want to undergo any more chemo. Do you think your hospital can do anything for her?

Dear Elaine, we are sorry to hear about your niece’s diagnosis. We are investigating novel treatments that don’t involve chemotherapy for people with advanced cancer in clinical trials. If she is interested in exploring her eligibility for a clinical trial, please call our Physician Referral Service at 800-525-2225 (Monday through Friday 8:30 am to 5:30 pm). Thank you for reaching out to us.

Hi. On April 30th, I was diagnosed with renal cancer. Scans and MR I did not find the tumor to be metastatic even though the size of it was 12 santimeters. The tumor was spread on adrenaline gland and vessels connected to the kidney. Everything was successfully removed but the pathology showed that it was synovial cell carcinoma. No treatments were done after the surgery. An oncologist at Fox Chase suggested 6 sessions of Chimo therapy. Do you deal with synovial carcinomas of kidneys?

Dear Mike, we are sorry to hear about your diagnosis. Our experts see people with all types of cancer, including the rarest forms of the disease. If you would like to make an appointment with one of our specialists for a second opinion, please call our Physician Referral Service at 800-525-2225. Thank you for reaching out to us.

I started with a 15 cm solitary fibrous tumor (sarcoma) in pleura. Aug '13 thorocotomy resection removal of lower left lobe of lung. Repeat thorocotomy of 8 cm tumor on diaphragm/pleura Sep.'14. Two nodules in R lung treated with microwave ablation Sep '15. Third thorocotomy May '16 in same location, between esophagus/aorta, just above diaphragm. Now CT shows numerous nodules in both lungs, some stable, some growing, most in 5 mm range. Doc is looking into trials; we have discussed a drug treatment which restricts capillary growth to limit tumor growth. She says likely we will not take any action until next CT scan in 3 mos. Should I get a second opinion?