Bone and soft tissue sarcomas are a diverse group of malignant tumors originating from mesenchymal tissues. The Sarcoma Expert Committee of the Chinese Society of Clinical Oncology (CSCO) organized a multi-expert consensus to standardize the clinical application of antiangiogenic tyrosine kinase inhibitors in these diseases. The consensus synthesizes domestic and international evidence available up to October 2025 and integrates expert clinical experience to produce practical recommendations for clinicians.
These tumors are highly heterogeneous in histology and clinical behavior. At presentation, roughly 20%–25% of malignant bone tumors and 10%–15% of malignant soft tissue tumors already have metastases. During the course of treatment, an additional 30%–50% of patients may develop distant metastases and progress to advanced-stage disease. For advanced sarcoma, first-line systemic therapy remains primarily chemotherapy, while standardized options for second-line and subsequent therapy are lacking. The consensus notes that immunotherapy has meaningful efficacy only in specific sarcoma subtypes.
Antiangiogenic tyrosine kinase inhibitors target pathways involved in angiogenesis and can remodel the tumor microenvironment. By inhibiting vascular endothelial growth and related signaling, tyrosine kinase inhibitors (TKI) may limit tumor perfusion and alter immune and stromal interactions in the tumor milieu. Clinical experience and studies have supported the activity of TKIs in various sarcoma subtypes, prompting expansion of their clinical application from later-line therapy into roles such as first-line combination, maintenance therapy, and neoadjuvant use.
The consensus was developed by 51 experts convened by the CSCO Sarcoma Expert Committee. The group applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to integrate available evidence from domestic and international sources through October 2025. Where high-quality evidence was limited, expert clinical experience was used to inform recommendations. The process and grading details are described in the full text.
The consensus condensed clinical uncertainties into eight core clinical questions focusing on the clinical application of TKIs in bone and soft tissue sarcomas. These questions guided literature review and recommendation formulation, targeting practical issues clinicians face when considering TKIs.
The committee produced 12 recommendations addressing selection of indications for TKI therapy in sarcoma patients. Recommendations consider disease subtype, stage, prior treatments, and the evolving evidence base. The guidance aims to help clinicians decide when TKI therapy is appropriate versus alternative systemic or local treatments.
The consensus recognizes that TKIs have moved beyond second- and later-line roles and into earlier-stage strategies in some contexts. Recommendations cover optimal timing and sequencing, including use as part of first-line combination regimens, as maintenance after initial disease control, and in the neoadjuvant setting to potentially downstage disease prior to surgery. Specific timing decisions are to be individualized based on histology, disease burden, prior therapies, and multidisciplinary assessment.
Combination approaches, including TKIs plus chemotherapy or other modalities, are discussed as strategies to enhance efficacy. The committee outlines considerations for combining agents, balancing potential synergistic benefits against additive toxicity. The consensus emphasizes individualized regimen selection and close monitoring when combining TKIs with other systemic or local therapies.
Perioperative use of TKIs raises special considerations due to effects on wound healing and vascular biology. The consensus includes recommendations on perioperative timing and management to minimize surgical complications while preserving oncologic effectiveness. Clinicians are advised to coordinate decisions within multidisciplinary teams and to follow specific perioperative guidance as detailed in the full text.
TKI-associated adverse events require proactive recognition and standardized management strategies. The consensus provides recommendations on monitoring, supportive care, dose modification, and when to interrupt or discontinue therapy. Effective toxicity management is emphasized as essential to maintain therapeutic benefit and patient safety.
The overarching goal of the CSCO consensus is to provide scientific, evidence-informed guidance for Chinese clinicians on TKI use in sarcoma, to standardize practice, enhance treatment effectiveness, and improve patient prognosis. The recommendations are intended to be practical, applicable to routine clinical settings, and adaptable as new evidence emerges.
This consensus is published in Zhonghua Yi Xue Za Zhi (2026 Aug 25;106(31):3234–3248) with DOI 10.3760/cma.j.cn112137-20260222-00507 and PubMed PMID 42618500. The article is authored by the Sarcoma Expert Committee, Chinese Society of Clinical Oncology (CSCO). All authors declared no conflicts of interest. MeSH indexing for the article includes Angiogenesis Inhibitors/therapeutic use, Bone Neoplasms, Protein Kinase Inhibitors/therapeutic use, Sarcoma/drug therapy, and Tyrosine Kinase Inhibitors.
Note: This rewritten summary is limited to content reported in the PubMed abstract and bibliographic record; detailed recommendation text, grading labels, and specific regimen-level guidance are available only in the full consensus document referenced in the citation.