Trabectedin is a chemotherapeutic agent that interferes with translation in tumor cells. It is active in liposarcoma and is currently approved for patients with advanced disease. Does it also enhance the response to neoadjuvant radiation for early stage disease? In the single arm phase 2 TRASTS trial, 46 patients with myxoid liposarcoma of the extremity or trunk received neoadjuvant RT (45 Gy in 25 fractions) and 3 cycles of trabectedin. The trial was designed to show a 70% response rate by RECIST criteria, which unfortunately was not met as the actual rate was 22%. Pathologic response was more encouraging. The pathologic complete response rate was 13%, and over half of patients (51%) had <10% viable tumor remaining tumor after neoadjuvant therapy. | Sanfilippo, JAMA Oncol 2023
