Treatments

Standard treatment approaches include:

• Surgery: Surgery is the cornerstone of treatment for synovial sarcoma and is aimed at completely removing the tumor with clear margins. Achieving clear margins (no cancer cells at the edges of the removed tissue) is critical to reducing the risk of recurrence. In some cases, amputation may be necessary if the tumor cannot be fully removed while preserving the affected limb. Advances in surgical techniques have improved the ability to remove tumors while preserving function.

• Radiation: Radiation therapy is frequently used before or after surgery to target cancer cells that may remain in the area. Pre-surgical radiation (neoadjuvant) can shrink the tumor, making it easier to remove, while post-surgical radiation (adjuvant) is often used to treat the tumor bed, reducing the risk of recurrence by targeting microscopic cancer cells that may remain after surgery.

  Advanced techniques, such as intensity-modulated radiation therapy (IMRT) and proton radiation therapy, allow precise targeting of the tumor while minimizing damage to surrounding healthy tissue. Proton radiation therapy, in particular, delivers high doses of radiation directly to the tumor or tumor bed, while significantly reducing exposure to nearby organs and critical structures. This makes it especially beneficial in treating tumors located near sensitive areas like the lungs, heart, or chest wall.

• Chemotherapy: Chemotherapy is a key component of synovial sarcoma treatment, particularly for high-grade tumors, advanced cases, or when metastasis is present. It is often used to shrink tumors before surgery (neoadjuvant therapy), to eliminate remaining cancer cells after surgery (adjuvant therapy), or to manage metastatic disease. While doxorubicin (Adriamycin) and ifosfamide remain the first-line chemotherapy regimen, several other drugs and targeted therapies are also used based on the individual patient’s condition and response to treatment.

  • Doxorubicin (Adriamycin) + Ifosfamide: This combination is the most widely used first-line chemotherapy for synovial sarcoma. It has shown effectiveness in shrinking tumors and improving progression-free survival in certain patient populations. It is typically administered in cycles, either alone or combined with other drugs, depending on the patient’s tolerance and disease stage.

For patients whose cancer does not respond to first-line chemotherapy or who experience recurrence, additional chemotherapy drugs may be considered:

• • Trabectedin (Yondelis): Approved for soft tissue sarcomas, this drug works by damaging DNA in cancer cells, leading to tumor suppression. It is particularly useful in patients who have progressed on prior treatments.

• • Gemcitabine (Gemzar) + Docetaxel (Taxotere): This combination is commonly used for various soft tissue sarcomas, including synovial sarcoma, especially in patients who do not respond to doxorubicin-based treatments.

Targeted Therapy and Immunotherapy

For patients with advanced or metastatic disease, targeted therapies and immunotherapies are becoming increasingly important.

• • Pazopanib (Votrient): An FDA-approved targeted therapy for advanced soft tissue sarcomas, including synovial sarcoma, Pazopanib works by blocking tumor blood vessel formation (angiogenesis) and tumor growth. It is typically used in patients who have already received prior chemotherapy. 

• • Afamitresgene Autoleucel (Tecelra): A newly approved T cell receptor gene therapy (FDA-approved in 2024) for unresectable or metastatic synovial sarcoma in patients who have received previous chemotherapy. This personalized immunotherapy modifies a patient’s own immune cells to target and destroy cancer cells expressing the MAGE-A4 antigen, a marker found in many synovial sarcomas. 

The Future of Chemotherapy and Targeted Treatments

Ongoing research and clinical trials are expanding treatment options for synovial sarcoma. Next-generation sequencing (NGS) and genetic profiling are helping doctors identify individualized treatment approaches, including experimental therapies and clinical trial enrollment.

Patients diagnosed with synovial sarcoma should seek care at a major cancer center with sarcoma specialists to ensure access to the latest treatments and expert guidance on therapy selection.

Clinical Trials

Clinical trials offer access to cutting-edge treatments, including immunotherapies, targeted therapies, and novel drug combinations. Targeted therapies focus on specific genetic changes, such as the SS18-SSX fusion gene, which drives synovial sarcoma. 

Participation in clinical trials can be an important option for patients, especially when standard treatments are not effective.