According to a commentary, this study is the first to show the value of second-line therapy in a randomised fashion versus best supportive care. It notes that the findings are in contrast to a European phase 2b study comparing two trabectedin schedules to standard doxorubicin treatment which found that the proportion of patients achieving a response after treatment with doxorubicin was higher than that seen in more than a decade before, and both trabectedin schedules had to be stopped due to futility. In the current study, the commentator notes that the population is about a decade younger (median 39 years) than typically reported, and in the best supportive care group, 61% of the patients had ≥2 lines of previous treatment compared with 30% in the trabectedin group. In addition, there was an imbalance between histologies in the study as four more patients in the trabectedin group had myxoid liposarcoma, which is known to respond well to trabectedin, whilst more aggressive subtypes such as synovial sarcoma or clear-cell sarcoma were disproportionally present in the best supportive care group. The commentator also highlights that tumour grading as the most important prognostic factor was not addressed in the analysis, and allowing a patient aged 40 years with a metastatic high-grade sarcoma to be assigned to best supportive care would probably not have happened had the trial been done in a European setting.