State of Care: Sarcoma

Sarcoma is one of the rarest and most complex groups of cancers, encompassing more than 100 distinct subtypes. As advances in genomics, precision medicine, and immunotherapy reshape how these diseases are understood and treated, we spoke with Igor Matushansky, MD, PhD, a medical oncologist specializing in sarcoma at the Herbert Irving Comprehensive Cancer Center, about the latest breakthroughs, promising clinical trials, and how Columbia is helping move the field forward.  

Sarcoma has more than 100 different subtypes. How does our understanding of its biology influence treatment today? 

One of the biggest shifts in the sarcoma landscape has been realizing just how diverse sarcomas really are. Advances in genomic sequencing, molecular diagnostics, and computational biology have allowed researchers to identify more sarcoma subtypes. In some cases, those discoveries have led directly to new targeted treatments.  

At the same time, this growing understanding has made sarcoma care more complex. Many of these subtypes are extremely rare, making it challenging to study them in large clinical trials – there are simply not enough patients for traditionally-designed clinical trials. Increasingly, physicians are moving toward treating each patient's sarcoma based on its unique biology rather than relying on a one-size-fits-all approach. 

What recent advances in sarcoma treatment are you most excited about? 

We're finally seeing meaningful progress across several rare sarcoma subtypes. 

Recent clinical trial results have introduced new treatment options – including the CDK4 inhibitor abemaciclib - for first-line metastatic dedifferentiated liposarcoma – a disease that has historically had few effective therapies. Researchers are also evaluating a new tyrosine kinase inhibitor that may eventually replace treatments that have been the standard of care for gastrointestinal stromal tumors (GIST) for more than two decades. 

We're also seeing encouraging advances in rare tumors like desmoid tumors, where new targeted therapies have recently been approved. 

Many of the more common adult soft tissue sarcomas still rely on chemotherapy treatments that have remained largely unchanged for decades.  

What role is immunotherapy playing in sarcoma treatment? 

While highly targeted cell therapies have shown remarkable promise for small groups of patients with rare sarcoma subtypes, I believe one of the most significant advances has been combining immunotherapy with radiation therapy before surgery. Clinical trial results have shown that this approach can significantly improve the amount of time patients remain cancer-free after treatment. 

At Columbia, we've incorporated this strategy into our multidisciplinary treatment program. Because this approach can benefit a broader range of patients, I believe it has the potential to make a greater overall impact on sarcoma care than some of the more highly specialized cell therapies. 

We're also seeing encouraging results from studies combining immunotherapy with standard chemotherapy, many of which have shown higher response rates when immunotherapy is added. 

How are clinical trials helping improve sarcoma care at Columbia? 

Clinical trials are central to everything we do, and our program is built around three pillars: participating in national and industry-sponsored clinical trials, collaborating through leading sarcoma research consortia, and developing investigator-initiated studies at Columbia. One area we're particularly excited about is expanding our "N-of-1" approach, which uses advanced molecular analysis to better predict which treatment is most likely to benefit an individual patient's tumor. It also helps address the challenges of developing clinical trials for such a rare cancer. 

What makes Columbia's approach to sarcoma care unique? 

Sarcoma treatment often involves surgery, radiation therapy, medical oncology, pathology, radiology, and rehabilitation. Instead of treating each therapy as a separate step, we increasingly combine treatments when evidence shows they work better together. At Columbia, we do an exceptional job of bringing those disciplines together from the beginning, so patients experience one coordinated treatment plan rather than moving through an assembly line of separate appointments. . That level of collaboration means a much more seamless experience for our patients, and a treatment plan that is designed by multiple experts at once leading to what we believe are better outcomes.