Inclusion Criteria:

• Age 18 - 85 years. Patients under 18 years, should be fully grown (prove of fused growth plates).
• Patients with histological evidence of advanced unresectable and/or metastatic high-gradesoft tissue sarcoma (grade 2 - 3 according to the FNLCC grading system) not amenable to curative treatment with surgery or radiotherapy.
  • The following tumor types are included:
    • Malignant fibrous histiocytoma (undifferentiated pleomorphic sarcoma);
    • Myxoid and round cell liposarcoma, pleomorphic liposarcoma or dedifferentiated liposarcoma;
    • Myxofibrosarcoma intermediate and high-grade;
    • Fibrosarcoma;
    • Leiomyosarcoma;
    • Angiosarcoma;
    • Unclassified sarcoma NOS.
  • The following tumor types will not be included:
    • GIST;
    • Mixed mesodermal tumor;
    • Synovial sarcoma;
    • Malignant peripheral nerve sheath tumor;
    • Epithelioid sarcoma;
    • Embryonal rhabdomyosarcoma;
    • Chondrosarcoma;
    • Malignant mesothelioma;
    • Neuroblastoma;
    • Osteosarcoma;
    • Ewing's sarcoma / primitive neuroectodermal tumor;
    • Desmoplastic small round cell tumor;
    • Alveolar soft part sarcoma;
    • Pleomorphic rhabdomyosarcoma;
    • Alveolar rhabdomyosarcoma.
• Patients must have at least one unidimensionally measurable lesion by computed tomography as defined by RECIST criteria 1.1. If only 1 lesion is present at screening, this lesion should not have been irradiated during previous treatments.
• Life expectancy of at least 3 months in the judgment of the investigator.
• ECOG ≤ 2.
• Documented negative test for HIV-HBV-HCV. For HBV serology: the determination of HBsAg, anti-HBsAg-Ab and anti-HBcAg-Ab is required. In patients with serology documenting previous exposure to HBV (i.e., anti-HBs Ab with no history of vaccination and/or anti-HBc Ab), negative serum HBV-DNA is required. For HCV: HCV-RNA or HCV antibody test. Subjects with a positive test for HCV antibody but no detection of HCV-RNA indicating no current infection are eligible.
• Female patients: negative serum pregnancy test for women of childbearing potential (WOCBP)* within 14 days of starting treatment. WOCBP must agree to use, from the screening to six months following the last study drug administration, highly effective contraception methods, as defined by the "Recommendations for contraception and pregnancy testing in clinical trials" issued by the Head of Medicine Agencies' ClinicalTrial Facilitation Group (www.hma.eu/ctfg.html) and which include, for instance, progesterone-only or combined (estrogen- and progesterone-containing) hormonal contraception associated with inhibition of ovulation, intrauterine devices, intrauterine hormone-releasing systems, bilateral tubal occlusion, vasectomized partner or sexual abstinence.
• Male patients: Male subjects able to father children must agree to use two acceptable methods of contraception throughout the study (e.g., condom with spermicidal gel). Double-barrier contraception is required.
  * Women of childbearing potential are defined as females who have experienced menarche, are not postmenopausal (12 months with no menses without an alternative medical cause) and are not permanently sterilized (e.g., tubal occlusion, hysterectomy, bilateral oophorectomy or bilateral salpingectomy).
• Informed consent signed and dated to participate in the study.
• Willingness and ability to comply with the scheduled visits, treatment plan, laboratory tests and other study procedures

Exclusion Criteria:

• Prior therapy (except surgery and radiation) for unresectable or metastatic malignant soft tissue sarcoma.
• Previous treatment with anthracycline-containing chemotherapy.
• Radiotherapy within 4 weeks prior to therapy.
• Known history of allergy to TNFα, anthracyclines or other intravenously administered human proteins/peptides/antibodies.
• Absolute neutrophil count (ANC) < 1.5 x 10^9/L, platelets < 100 x 109/L and haemoglobin (Hb) < 9.0 g/dl.
• Chronically impaired renal function as expressed by creatinine clearance < 60 mL/min.
• Inadequate liver function (ALT, AST, ALP or total bilirubin ≥ 2.5 x ULN)
• Any severe concomitant condition which makes it undesirable for the patient to participate in the study or which could jeopardize compliance with the protocol.
• History within the last year of cerebrovascular disease and/or acute or subacute coronary syndromes including myocardial infarction, unstable or severe stable angina pectoris.
• Heart insufficiency (> Grade II, New York Heart Association (NYHA) criteria).
• Clinically significant cardiac arrhythmias or requiring permanent medication.
• Abnormalities observed during baseline ECG and Echocardiogram investigations that are considered as clinically significant by the investigator. Subjects with current, or a history of QT/QTc prolongation would be excluded. In particular:
  • patients with a marked prolongation of QT/QTc interval (e.g., repeated demonstration of QTc >480 milliseconds using Fredricia's QT correction formula) are excluded;
  • patients with a history of risk factors for Torsades de Pointes (e.g., heart failure, hypokalemia, family history of prolonged QT syndrome) are excluded;
  • patients who require the use of concomitant medications that prolong the QT/QTc interval are excluded.
• Uncontrolled hypertension, despite optimal therapy.
• Ischemic peripheral vascular disease (Grade IIb-IV according to Leriche-Fontaine classification).
• Severe diabetic retinopathy such as severe non-proliferative retinopathy and proliferative retinopathy.
• Major trauma including major surgery (such as abdominal/cardiac/thoracic surgery) within 4 weeks of administration of study treatment.
• Pregnancy or breast-feeding.
• Requirement of chronic administration of corticosteroids or other immunosuppressant drugs. Limited use of corticosteroids to treat or prevent acute hypersensitivity reactions is not considered an exclusion criterion.
• Presence of active and uncontrolled infections or other severe concurrent disease which, in the opinion of the investigator, would place the patient at undue risk or interfere with the study.
• Known active or latent tuberculosis (TB).
• Concurrent malignancies other than Soft Tissue Sarcoma, unless the patient has been disease-free for at least 2 years.
• Growth factors or immunomodulatory agents within 7 days prior to the administration of study treatment.
• Serious, non-healing wound, ulcer or bone fracture.
• Allergy to study medication or excipients in study medication.
• Concurrent therapy with anticoagulants.
• Concurrent use of other anti-cancer treatments or agents other than study medication.
• Any recent live vaccination within 4 weeks prior to treatment or plan to receive vaccination during the study.

Eligibility last updated 12/10/21. Questions regarding updates should be directed to the study team contact.