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Background  Well-designed clinical trials are of great importance in validating novel treatments and ensuring an evidence-based approach for sarcoma. This study aimed to provide a comprehensive landscape of the characteristics of metastatic or advanced sarcoma clinical trials using the substantial resource of the ClincialTrials.gov database.    Methods  We identified 260,755 trials registered with ClinicalTrials.gov in the last 20 years, and 277 of them were eligible for inclusion. The baseline characteristics were ascertained for each trial. The trials were systematically reviewed to validate their classification into 96 trials registered before 2008 and 181 trials registered between 2008 and 2017.    Results  We found that in the last decade, metastatic and advanced sarcoma trials were predominantly phase II-III studies ( p  = 0.048), were more likely to be ≥2 arms (17.7% vs 35.3%, respectively;  p  = 0.007), and were more likely to use randomized (13.5% vs 30.4%;  p  = 0.002) and double-blinded (2.1% vs 9.4%;  p  = 0.024) assignment than trials registered before 2008. Furthermore, in the last 10-year period, metastatic sarcoma trials were more likely to be conducted in Asia. Treatment involving target therapy and immunotherapy were more common (71.8% vs 37.5%;  p  < 0.001) than in previous years.    Conclusions  Our data showed provocative changes in the sarcoma landscape and demonstrated that the incidence of clinical trials with target therapy and immunotherapy is increasing. These findings emphasize the desperate need for novel strategies, including target therapy and immunotherapy, to improve the outcomes for patients with advanced sarcoma.    Electronic supplementary material  The online version of this article (10.1186/s12885-018-5163-2) contains supplementary material, which is available to authorized users.

The changing landscape of phase II/III metastatic sarcoma clinical trials—analysis of ClinicalTrials.gov