Pharmacogenetic Profiling in High-Risk Soft Tissue Sarcomas Treated with Neoadjuvant Chemotherapy.

Neoadjuvant chemotherapy based on anthracyclines and ifosfamide for high-risk soft tissue sarcomas (STS) of the extremities and trunk is a controversial treatment option. There are substantial interindividual differences in clinical outcomes in patients treated with neoadjuvant chemotherapy. The aim of this study was to evaluate, as biomarkers, polymorphisms in genes encoding drug-metabolizing enzymes, drug transporters, or drug targets and their association with toxicity and survival in STS patients treated with neoadjuvant chemotherapy. We analysed variants in genes involved in anthracycline metabolism (, , , , and ) and in ifosfamide catabolism () in 79 treated patients. Two genes showed significant association after adjusted multivariate analysis: and . In patients treated with anthracyclines, rs3740066 was associated with risk of febrile neutropenia ( = 0.031), and with decreased overall survival (OS) ( = 0.024). rs2273697 was associated with recurrence-free survival (RFS) ( = 0.024). In patients treated with ifosfamide, rs3764435 was associated with RFS ( = 0.046). Our pharmacogenetic study shows for the first time that variants in genes regulating the metabolism of neoadjuvant chemotherapy may be helpful to predict toxicity and survival benefit in high-risk STS treated with neoadjuvant chemotherapy. Further validation studies are needed to establish their clinical utility.