With the Tsunami of Immunotherapy, Will Soft Tissue Sarcoma Remain an Immune Desert?

Soft tissue sarcomas (STSs) are rare, aggressive and heterogeneous malignancies with poor outcomes. They include more than 50 different histologic subtypes with variable molecular and cytogenetic profiles responsible for the heterogeneity of these tumors. Radical surgery, chemotherapy and radiation therapy are still the mainstay of treatment with limited therapeutic options in case of metastatic and locally advanced unresectable disease. The current available cytotoxic and targeted therapies are only offering short living disease control. In the era of immunotherapy, STSs were affected by this ‘tsunami’ with very promising results, but larger randomized trials are still needed to prove their benefit in terms of survival and efficacy. They are not included yet in the standard of care. In this review of the literature, we are developing the active immunotherapeutic strategies (vaccines), as well as the passive strategies (adoptive cell therapy) and the checkpoint inhibitors emphasizing on the most recent results and on the limitation of the immunotherapy in this heterogenic media.