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Parisi S, Gambardella C, Iovino F, Ruggiero R, Lucido FS, Nesta G, Tolone S, Brusciano L, Fisone F, Mongardini FM, Cozzolino G, Della Corte CM, Napolitano S, Orditura M, Esposito R, Docimo L. Post-Irradiation Breast Angiosarcoma: All the Possible Treatments and Electrochemotherapy. Case Report and Literature Review. J Clin Med 2024; 13:567. [PMID: 38256700 PMCID: PMC10816174 DOI: 10.3390/jcm13020567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 12/27/2023] [Accepted: 01/06/2024] [Indexed: 01/24/2024] Open
Abstract
Breast angiosarcoma is a rare malignancy, accounting for less than 1% of all soft tissue cancers. It comprises primitive and secondary subtypes, such as radiogenic breast angiosarcoma (RAS). Despite multimodal treatment, angiosarcomas represent an incurable disease for many patients and a significant cause of deterioration in their quality of life. Surgery is a cornerstone in management, but high recurrence rates are reported. Electrochemotherapy (ECT) is a practicable locoregional treatment for patients with advanced angiosarcoma as part of a multimodal therapeutic strategy. The palliative benefits of ECT include optimal patient compliance, good local hemostasis control, and positive local responses. Since only 22 cases are described in the literature, we reported a rare case of RAS treated with ECT after a multidisciplinary approach, including Next Generation Sequencing (NGS). A literature review on the feasibility of ECT in RAS management was also performed.
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Affiliation(s)
- Simona Parisi
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Claudio Gambardella
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Iovino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
- Department of Translational Medical Sciences, Division of General Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy
| | - Roberto Ruggiero
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesco Saverio Lucido
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giusiana Nesta
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Salvatore Tolone
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Luigi Brusciano
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Francesca Fisone
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Federico Maria Mongardini
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Giovanni Cozzolino
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Carminia Maria Della Corte
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Stefania Napolitano
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Michele Orditura
- Medical Oncology, Department of Precision Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (C.M.D.C.); (S.N.); (M.O.)
| | - Rosetta Esposito
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
| | - Ludovico Docimo
- Department of Advanced Medical and Surgical Sciences, School of Medicine, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (C.G.); (R.R.); (F.S.L.); (S.T.); (L.B.); (L.D.)
- Division of General, Oncological, Mini-Invasive and Obesity Surgery, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (F.I.); (G.N.); (F.F.); (F.M.M.); (G.C.); (R.E.)
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Kim WJ, Kim HK. Current understanding of angiosarcoma: disease biology and evolving treatment. Arch Craniofac Surg 2023; 24:203-210. [PMID: 37919906 PMCID: PMC10622948 DOI: 10.7181/acfs.2023.00409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 08/28/2023] [Accepted: 09/12/2023] [Indexed: 11/04/2023] Open
Abstract
Angiosarcoma is a very rare soft tissue sarcoma that originates from endothelial cells and typically has a poor prognosis. It is most commonly found in elderly white men and can occur anywhere in the body, particularly in the head, neck, and scalp. Patients who have undergone previous radiation treatment or who have chronic lymphedema also face an elevated risk of this condition. Various genetic changes are suspected to contribute to the development of angiosarcoma, and these changes have been identified as potential targets for treatment. For localized disease, wide surgical resection is often the prudent course of action. A multidisciplinary approach, which may include surgery, radiotherapy, systemic chemotherapy, or immunotherapy, is typically the most effective way to achieve favorable outcomes. In this review, we discuss the general understanding of angiosarcoma and its management, with a particular focus on the current evolving treatments for the disease.
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Affiliation(s)
- Woo Ju Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University School of Medicine, Gwangmyeong, Korea
| | - Han Koo Kim
- Department of Plastic and Reconstructive Surgery, Chung-Ang University Hospital, Chung-Ang University School of Medicine, Seoul, Korea
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Benton A, Terwilliger E, Moriarty NM, Liu B, Murphy A, Maluvac H, Shu M, Gartenhaus LE, Janson ND, Pfeffer CM, Utturkar SM, Parkinson EI, Lanman NA, Hanna JA. Target gene regulatory network of miR-497 in angiosarcoma. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.24.559218. [PMID: 37808715 PMCID: PMC10557590 DOI: 10.1101/2023.09.24.559218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Angiosarcoma (AS) is a vascular sarcoma that is highly aggressive and metastatic. Due to its rarity, treatment options for patients are limited, therefore more research is needed to identify possible therapeutic vulnerabilities. We previously found that conditional deletion of Dicer1 drives AS development in mice. Given the role of DICER1 in canonical microRNA (miRNA) biogenesis, this suggests that miRNA loss is important in AS development. After testing miRNAs previously suggested to have a tumor-suppressive role in AS, microRNA-497-5p (miR-497) suppressed cell viability most significantly. We also found that miR-497 overexpression led to significantly reduced cell migration and tumor formation. To understand the mechanism of miR-497 in tumor suppression, we identified clinically relevant target genes using a combination of RNA-sequencing data in an AS cell line, expression data from AS patients, and target prediction algorithms. We validated miR-497 direct regulation of CCND2, CDK6, and VAT1. One of these genes, VAT1, is an understudied protein that has been suggested to promote cell migration and metastasis in other cancers. Indeed, we find that pharmacologic inhibition of VAT1 with the natural product Neocarzilin A reduces AS migration. This work provides insight into the mechanisms of miR-497 and its target genes in AS pathogenesis.
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Affiliation(s)
- Annaleigh Benton
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Emma Terwilliger
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Noah M. Moriarty
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN USA
| | - Bozhi Liu
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Ant Murphy
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Hannah Maluvac
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Mae Shu
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Lauren E. Gartenhaus
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Nimod D. Janson
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Claire M. Pfeffer
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Sagar M. Utturkar
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
| | - Elizabeth I. Parkinson
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
- Department of Medicinal Chemistry and Molecular Pharmacology, Purdue University, West Lafayette, IN USA
- Department of Chemistry, Purdue University, West Lafayette, IN, USA
| | - Nadia A. Lanman
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
- Department of Comparative Pathobiology, Purdue University, West Lafayette, IN USA
| | - Jason A. Hanna
- Department of Biological Sciences, Purdue University, West Lafayette, IN USA
- Purdue University Institute for Cancer Research, Purdue University, West Lafayette, IN USA
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Niwa M, Tomita N, Takaoka T, Takano H, Makita C, Matsuo M, Adachi S, Oshima Y, Yamamoto S, Kuno M, Miyakawa A, Okazaki D, Torii A, Kita N, Takano S, Nakamura M, Kato H, Morita A, Hiwatashi A. Clinical Outcomes of Radiation Therapy for Angiosarcoma of the Scalp and Face: A Multi-Institutional Observational Study. Cancers (Basel) 2023; 15:3696. [PMID: 37509356 PMCID: PMC10378060 DOI: 10.3390/cancers15143696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 07/17/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Angiosarcoma of the scalp and face (ASF) is a rare, aggressive tumor often treated with multimodal therapy, including radiation therapy (RT). This study assessed RT outcomes for ASF and identified prognostic factors. Data from 68 non-metastatic ASF patients undergoing RT with or without other therapies were analyzed. Median radiation dose was 66 Gy in 33 fractions (interquartile range (IQR) 60-70 Gy in 28-35 fractions). Local control (LC), progression-free survival (PFS), and overall survival (OS) rates were calculated using Kaplan-Meier analysis. Multivariate analyses and adverse event evaluation were conducted. Median patient age was 75 years (IQR 71-80 years), with a median follow-up of 17 months (IQR 11-42 months). One-/three-year LC rates were 57/37%, PFS rates were 44/22%, and OS rates were 81/44%. Multivariate analyses showed that an equivalent dose in a 2 Gy fraction (EQD2) >66 Gy correlated with improved LC (HR 2.35, 95% CI 1.03-5.32, p = 0.041). Combining chemotherapy (HR 2.43, 95% CI 1.08-5.46, p = 0.032) or surgery (HR 2.41, 95% CI 1.03-5.59, p = 0.041) improved PFS. No factors influenced OS. Late grade 3+ toxicities occurred in 1%, with one patient developing a grade 4 skin ulcer. These findings suggest that EQD2 > 66 Gy and combining chemotherapy or surgery can enhance LC or PFS in ASF. Further prospective studies are needed to determine the optimal treatment strategy for this rare malignancy, particularly in elderly patients.
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Affiliation(s)
- Masanari Niwa
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Natsuo Tomita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Taiki Takaoka
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hirota Takano
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Chiyoko Makita
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Masayuki Matsuo
- Department of Radiation Oncology, Gifu University Hospital, Gifu 500-1194, Japan
| | - Sou Adachi
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Yukihiko Oshima
- Department of Radiology, Aichi Medical University Hospital, Nagakute 480-1195, Japan
| | - Shintaro Yamamoto
- Department of Radiology, Japan Community Health Care Organization Chukyo Hospital, Nagoya 457-8510, Japan
| | - Mayu Kuno
- Department of Radiation Oncology, Ichinomiya Municipal Hospital, Ichinomiya 491-8558, Japan
| | - Akifumi Miyakawa
- Department of Radiation Oncology, National Hospital Organization Nagoya Medical Center, Nagoya 460-0001, Japan
| | - Dai Okazaki
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akira Torii
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Nozomi Kita
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Seiya Takano
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
| | - Akio Hiwatashi
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan
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Conci N, Grilli G, Dall’Olio FG. Principles of medical and oncological management of giant masses of the mediastinum: a narrative review. MEDIASTINUM (HONG KONG, CHINA) 2022; 6:35. [PMID: 36582971 PMCID: PMC9792870 DOI: 10.21037/med-21-54] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/28/2022] [Indexed: 01/01/2023]
Abstract
Background and Objective Giant mediastinal tumors are represented by well-defined histological variants originating from different structures and compartments while their clinical presentation may be similar and characterized by the same set of symptoms, the well-known mediastinal syndrome (MS). In 80% of cases the MS is caused by malignant neoplasms, such as lung tumors, in 10-18% of cases by hematological neoplasms and in 2-3% by benign causes. In this review we investigated the medical treatment of main giant mediastinal tumors, focusing our interest on the objective response rate (ORR), as it represents the most suitable parameter to predict the volumetric reduction of the neoplasm and, consequently, the regression of their most severe complication, the MS. We will also cover the supportive and symptomatic treatment of MS. Methods We performed a deep analysis of the recent international literature published on PUBMED, UpToDate and Medline. The literature search was undertaken from origin until November 30th, 2021, and we only considered publications in English. Key Content and Findings Considering the variety of pathologies that can occur in the mediastinum, a rapid histological characterization of the neoplasm is mandatory. In fact, the treatment of these neoplasms includes different approaches, sometimes used in combination, which include chemotherapy, radiotherapy, and surgery. The vena cava syndrome (VCS), due to its high mortality, is considered an oncological emergency and, therefore, requires effective treatments carried out urgently, evaluated in multidisciplinary meeting. Conclusions The treatment of MS includes both antiblastic treatments and therapies directed to the symptoms. Among the former, chemotherapy, target therapy, radiation and surgery may be used, according to the etiology of MS. Among the latters, supportive therapies, interventional radiology procedures such as stenting may help manage this syndrome, despite the prognosis is poor in most cases and linked to the histology of the tumor, which therefore represents the most important prognostic factor.
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Affiliation(s)
- Nicole Conci
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy;,Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Giada Grilli
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy;,Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy
| | - Filippo G. Dall’Olio
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Via Giuseppe Massarenti, Bologna, Italy;,Division of Medical Oncology, IRCCS Azienda Ospedaliero-Universitaria Di Bologna, Bologna, Italy;,Department of Cancer Medicine, Gustave Roussy, Villejuif, France
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Riedel RF, Chua V, Moradkhani A, Krkyan N, Ahari A, Osada A, Chawla SP. Results of NC-6300 (Nanoparticle Epirubicin) in an Expansion Cohort of Patients with Angiosarcoma. Oncologist 2022; 27:809-e765. [PMID: 35920783 PMCID: PMC9526480 DOI: 10.1093/oncolo/oyac155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 06/21/2022] [Indexed: 11/29/2022] Open
Abstract
Background NC-6300 is a novel epirubicin (EPI) drug conjugated polymeric micelle developed using cutting-edge micellar nanoparticle technology. The nanoparticle epirubicin conjugates EPI to a polymer via a pH-sensitive linker which enables the selective EPI release into tumor. Tumor activity was observed in a monotherapy phase Ib trial, where two of two patients with angiosarcoma achieved a partial response. To further explore the activity of NC-6300 in angiosarcoma, an expansion cohort was undertaken. Methods Ten patients with angiosarcoma were enrolled in the expansion cohort. Patients were dosed using the recommended dose of 150 mg/m2 intravenously (IV) once every 3 weeks. The primary endpoint was progression-free survival. Results The most common adverse events (AEs) of any grade, regardless of the causal relationship with NC-6300, were neutropenia (90%), fatigue, and thrombocytopenia (60% each) and nausea (50%). The most common grades 3 and 4 AEs were neutropenia (80%), thrombocytopenia (40%), and anemia and leukopenia (20% each). The median progression-free survival (mPFS) for all subjects was 5.4 months. The mPFS was 3.8 months in subjects with prior anthracycline treatment and 8.2 months in subjects without prior anthracycline treatment. Conclusion NC-6300 was well tolerated, showing promising activity in angiosarcoma patients without prior anthracycline treatment. NC-6300 warrants further investigation (ClinicalTrials.gov Identifier: NCT03168061).
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Affiliation(s)
- Richard F Riedel
- Duke Cancer Institute, Duke University Medical Center, Durham, NC, USA
| | - Victoria Chua
- Sarcoma Oncology Research Center, Santa Monica, CA, USA
| | | | | | - Amir Ahari
- Sarcoma Oncology Research Center, Santa Monica, CA, USA
| | | | - Sant P Chawla
- Sarcoma Oncology Research Center, Santa Monica, CA, USA
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Malignant Vascular Tumors of the Head and Neck-Which Type of Therapy Works Best? Cancers (Basel) 2021; 13:cancers13246201. [PMID: 34944821 PMCID: PMC8699575 DOI: 10.3390/cancers13246201] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 12/13/2022] Open
Abstract
Simple Summary Malignant vascular tumors are extremely rare tumors with variable clinical courses, and few data on their clinical management are available. Diagnosis is difficult due to their wide morphologic appearance. The intent of the present review is to demonstrate the current knowledge and management on malignant vascular tumors of the head and neck area. The mainstay of treatment for malignant vascular tumors is surgery, but radiotherapy and chemotherapy are also parts of the treatment concept especially in angiosarcomas. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. Abstract Malignant vascular tumors of the head and neck are rare neoplasms with variable clinical presentation, wide age distribution, and variable clinical courses. The heterogeneous presentation of angiosarcomas and epithelioid hemangioendothelioma often leads to misdiagnosis and unsuitable treatment. While risk factors for angiosarcomas are previous radiation, chronic lymphedema, and exposure to arsenic, thorium oxide, or vinyl chloride, there are only limited and retrospective data available on prognostic factors in EHE. In both angiosarcomas and EHE, surgery is the mainstay of treatment. There is limited evidence regarding the role of radiotherapy in EHE, although EHE is considered relatively radiosensitive. In angiosarcomas, adjuvant radiotherapy is recommended according to retrospective case series. A standard medical therapy for metastasized malignant vascular tumors is lacking. Chemotherapy, which is effective in angiosarcoma, is mostly ineffective in EHE. Targeted therapy, antiangiogenetic drugs and immunotherapy have been studied as new treatment options. The goal of this review is to summarize the current data regarding malignant vascular tumors along with their diagnosis and management.
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Keltner CH, Lima APS, West M, Gundle KR, Fuss C, Davis LE. Primary Aortic Angiosarcoma: A Review of Two Cases Highlighting Unique Imaging and Clinical Characteristics. Radiol Cardiothorac Imaging 2021; 3:e210040. [PMID: 34498006 DOI: 10.1148/ryct.2021210040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/08/2021] [Accepted: 06/21/2021] [Indexed: 11/11/2022]
Abstract
Angiosarcomas are rare vascular connective tissue tumors originating from the tunica intima, media, or adventitia and may arise in large vessels. Here two cases of primary angiosarcoma of the aorta are described that highlight initial manifestations and unique complications from diffuse arterial tumor emboli, which led to delayed cancer diagnosis. In patients with aortic lesions, imaging characteristics must be thoughtfully reconciled with clinical scenarios, particularly in patients with no additional evidence of atherosclerosis or vasculitis. Keywords: Oncology, Neoplasms-Primary, MR-Angiography, Aorta © RSNA, 2021.
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Affiliation(s)
- Case H Keltner
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Ana Paula Santos Lima
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Malinda West
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Kenneth R Gundle
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Cristina Fuss
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
| | - Lara E Davis
- School of Medicine (C.H.K.), Department of Diagnostic Radiology (A.P.S.L., C.F.), Knight Cancer Institute (M.W., L.E.D.), and Department of Orthopaedics & Rehabilitation (K.R.G.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR 97239; and Operative Care Division, Portland VA Medical Center, Portland, Ore (K.R.G.)
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9
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Wagner MJ, Othus M, Patel SP, Ryan C, Sangal A, Powers B, Budd GT, Victor AI, Hsueh CT, Chugh R, Nair S, Leu KM, Agulnik M, Sharon E, Mayerson E, Plets M, Blanke C, Streicher H, Chae YK, Kurzrock R. Multicenter phase II trial (SWOG S1609, cohort 51) of ipilimumab and nivolumab in metastatic or unresectable angiosarcoma: a substudy of dual anti-CTLA-4 and anti-PD-1 blockade in rare tumors (DART). J Immunother Cancer 2021; 9:jitc-2021-002990. [PMID: 34380663 PMCID: PMC8330584 DOI: 10.1136/jitc-2021-002990] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 12/30/2022] Open
Abstract
Purpose Angiosarcoma is a rare aggressive endothelial cell cancer with high mortality. Isolated reports suggest immune checkpoint inhibition efficacy in angiosarcoma, but no prospective studies have been published. We report results for angiosarcoma treated with ipilimumab and nivolumab as a cohort of an ongoing rare cancer study. Methods This is a prospective, open-label, multicenter phase II clinical trial of ipilimumab (1 mg/kg intravenously every 6 weeks) plus nivolumab (240 mg intravenously every 2 weeks) for metastatic or unresectable angiosarcoma. Primary endpoint was objective response rate (ORR) per RECIST 1.1. Secondary endpoints include progression-free (PFS) and overall survival, and toxicity. A two-stage design was used. Results Overall, there were 16 evaluable patients. Median age was 68 years (range, 25–81); median number of prior lines of therapy, 2. Nine patients had cutaneous and seven non-cutaneous primary tumors. ORR was 25% (4/16). Sixty per cent of patients (3/5) with primary cutaneous scalp or face tumors attained a confirmed response. Six-month PFS was 38%. Altogether, 75% of patients experienced an adverse event (AE) (at least possibly related to drug) (25% grade 3–4 AE); 68.8%, an immune-related AE (irAE) (2 (12.5%), grade 3 or 4 irAEs (alanine aminotransferase/aspartate aminotransferase increase and diarrhea)). There were no grade 5 toxicities. One of seven patients in whom tumor mutation burden (TMB) was assessed showed a high TMB (24 mutations/mb); that patient achieved a partial response (PR). Two of three patients with PDL1 immunohistochemistry assessed had high PDL1 expression; one achieved a PR. Conclusion The combination of ipilimumab and nivolumab demonstrated an ORR of 25% in angiosarcoma, with three of five patients with cutaneous tumors of the scalp or face responding. Ipilimumab and nivolumab warrant further investigation in angiosarcoma. Trial registration number NCT02834013.
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Affiliation(s)
- Michael J Wagner
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA .,Medical Oncology, University of Washington, Seattle, Washington, USA
| | - Megan Othus
- SWOG Statistical and Data Management Center/Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Sandip P Patel
- Department of Medicine, UCSD Moores Cancer Center, La Jolla, California, USA
| | - Chris Ryan
- Department of Medicine, OHSU, Portland, Oregon, USA
| | - Ashish Sangal
- Western Regional Medical Center, Goodyear, Arizona, USA
| | - Benjamin Powers
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - G Thomas Budd
- Hematology and Medical Oncology, Cleveland Clinic, Cleveland, Ohio, USA
| | - Adrienne I Victor
- Department of Medicine, University of Rochester, Rochester, New York, USA
| | | | - Rashmi Chugh
- Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Suresh Nair
- Lehigh Valley Health Network, Allentown, Pennsylvania, USA
| | - Kirsten M Leu
- Nebraska Methodist Health System, Omaha, Nebraska, USA
| | - Mark Agulnik
- Medical Oncology & Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, California, USA.,Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Elad Sharon
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Edward Mayerson
- SWOG Statistical and Data Management Center/Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Melissa Plets
- SWOG Statistical and Data Management Center/Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Charles Blanke
- Department of Medicine, OHSU, Portland, Oregon, USA.,SWOG, Portland, Oregon, USA
| | - Howard Streicher
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, Maryland, USA
| | - Young Kwang Chae
- Department of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Razelle Kurzrock
- Department of Medicine, UCSD Moores Cancer Center, La Jolla, California, USA
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10
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Current Management of Angiosarcoma: Recent Advances and Lessons From the Past. Curr Treat Options Oncol 2021; 22:61. [PMID: 34097172 DOI: 10.1007/s11864-021-00858-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/31/2021] [Indexed: 01/18/2023]
Abstract
OPINION STATEMENT Despite their rarity, angiosarcomas are one of the most aggressive soft tissue sarcomas. Management can often be challenging due to their location and infiltrative nature. A multidisciplinary treatment approach is always warranted, but the recurrence remains high even for localized tumors despite multimodality treatment. In the metastatic setting, cytotoxic chemotherapies, targeted therapies, and, more recently, immunotherapy are used. The sequence of systemic therapies remains currently a topic of active investigation. Over the last couple of years, there have been significant advances in understanding angiosarcoma biology, most notably via patient-driven initiatives like the Angiosarcoma Project. The knowledge derived from such translational work has led to identifying potential biomarkers of response to treatments and exploring new therapeutic avenues. More clinical trials are underway to expand treatment options and improve patient outcomes.
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11
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Schöffski P, Timmermans I, Wildiers H, Dumez H, Hompes D, Christiaens M, Sciot R, Laenen A, Lee CJ, Meyskens T. Retrospective Analysis of the Clinical Presentation, Treatment and Outcome of Angiosarcoma in a Sarcoma Referral Center. Oncol Res Treat 2021; 44:322-332. [PMID: 33946082 DOI: 10.1159/000516000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 03/18/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Angiosarcoma (AS) is a rare subtype of soft tissue sarcoma. We performed a retrospective analysis of patient characteristics, treatments and prognostic factors in patients treated in a single sarcoma center. METHODS We reviewed records of patients treated between 1987 and 2018, categorized in 7 different subtypes according to tissue of origin and underlying risk factors. The Kaplan-Meier method was used to estimate overall survival (OS); the Cox proportional hazards model was used to study prognostic variables. RESULTS Among 134 patients, 30% had radiation-induced, 31% primary soft tissue, 24% cutaneous, 5% breast, 4% bone, 2% lymphedema-associated and 4% unknown primary AS. Key patient/disease characteristics varied between subgroups. The median OS was 22.0 months for the entire cohort, with 28.9% with a 5-year survival. Metastasis at diagnosis was seen in 23% of patients; 38% developed metachronous metastasis. Sixty-six (49%) patients received systemic therapy; common first-line treatments were doxorubicin (48%) and paclitaxel (39%), without a significant difference in OS between agents. Younger age, breast/radiation-induced AS, primary surgery and palliative chemotherapy were associated with better OS. Synchronous metastasis, soft tissue/unknown primary location correlated with poor survival. CONCLUSION AS is a very heterogeneous sarcoma subtype, with substantial variability in clinical presentation and survival among patient subsets. Prognosis is poor, and there is no difference in outcome comparing the 2 most frequently used chemotherapy agents in the first line, paclitaxel and doxorubicin.
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Affiliation(s)
- Patrick Schöffski
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Iris Timmermans
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Hans Wildiers
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Herlinde Dumez
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Daphne Hompes
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Melissa Christiaens
- Department of Radiotherapy/Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Raf Sciot
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Annouschka Laenen
- Leuven Center of Biostatistics and Statistic Bioinformatics, KU Leuven, Leuven, Belgium
| | - Che-Jui Lee
- Laboratory of Experimental Oncology, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Thomas Meyskens
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
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12
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Yagi T, Nakamura H, Wakamatsu T, Imura Y, Tamiya H, Sabe H, Yamashita K, Watanabe M, Takenaka S. Primary breast angiosarcoma with disseminated intravascular coagulation is successfully treated with self-subcutaneous unfractionated heparin calcium injection: A case report. Mol Clin Oncol 2021; 14:104. [PMID: 33815793 PMCID: PMC8010513 DOI: 10.3892/mco.2021.2266] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Accepted: 02/26/2021] [Indexed: 11/19/2022] Open
Abstract
Angiosarcoma is a rare sarcoma with a poor prognosis and is prone to disseminated intravascular coagulation (DIC), where DIC often interferes with chemotherapy. Primary angiosarcoma of the breast (PASB) is a type of angiosarcoma that is located in mammary parenchyma and is not associated with radiation exposure. The current study reported a 47-year-old female with DIC associated with PASB. The DIC of the patient relapsed during mono-chemotherapy with paclitaxel (PTX) after first-line anticoagulant therapy using thrombomodulin-α. The second-line danaparoid sodium therapy, followed by self-subcutaneous injection of unfractionated heparin calcium (UFH), resulted in long-term stabilization of DIC. Under this second-line anticoagulant therapy, the patient continued chemotherapy and chemoradiotherapy for >13 months in the outpatient setting without impairment of quality of life. The present case suggested that self-subcutaneous injections of UFH may be a useful therapeutic option for long-term control of DIC associated with PASB. However, further prospective clinical trails are needed to verify the efficacy of self-subcutaneous injection of UFH in similar settings.
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Affiliation(s)
- Toshinari Yagi
- Department of Outpatient Chemotherapy, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Harumi Nakamura
- Department of Diagnostic Pathology and Cytology, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Toru Wakamatsu
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Yoshinori Imura
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hironari Tamiya
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Hideaki Sabe
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Katsunari Yamashita
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Makiyo Watanabe
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
| | - Satoshi Takenaka
- Department of Orthopedic Surgery, Osaka International Cancer Institute, Osaka 541-8567, Japan
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13
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Lee JB, Ahn BC, Kim SH, Lee YH, Han JW, Jeon MK, Kim SH, Kim HS. Prognostic implications of PD-L1 expression in patients with angiosarcoma. Future Sci OA 2021; 7:FSO691. [PMID: 34046193 PMCID: PMC8147824 DOI: 10.2144/fsoa-2020-0211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Aim: There are limited data on the feasibility of programmed death ligand-1 (PD-L1) expression as a prognostic biomarker in metastatic angiosarcoma. Patients & methods: We retrospectively collected and analyzed the data on PD-L1 expression in 70 angiosarcoma patients who were diagnosed at our center between 2005 and 2019. Results: Thirteen (19%) patients had PD-L1 expression. Metastatic angiosarcoma patients who were PD-L1-negative (n = 24) showed longer median progression-free survival (4.9 vs 1.6 months; p = 0.04) and median overall survival (OS; 10.9 vs 5.4 months; p = 0.01) than those who were PD-L1-positive (n = 4). PD-L1 status proved to be a significant factor for OS. Conclusion: Metastatic angiosarcoma patients with PD-L1 expression showed shorter survival. PD-L1 status is an independent prognostic factor for OS in metastatic angiosarcoma patients. Angiosarcoma, a rare subtype of sarcoma, is highly aggressive and has poor prognosis. The majority of patients are diagnosed at advanced and metastatic stages, and treatment options for these subsets of patients are limited to cytotoxic chemotherapy. Validation of prognostic markers including PD-L1 expression remain to be fully carried out in metastatic angiosarcoma. In our study, we assessed the PD-L1 expression in metastatic angiosarcoma and its role as a prognostic biomarker.
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Affiliation(s)
- Jii Bum Lee
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Beung-Chul Ahn
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Seung Hyun Kim
- Department of Orthopedic Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Woo Han
- Department of Pediatric Hemato-Oncology, Yonsei University College of Medicine, Seoul, Korea
| | - Min Kyung Jeon
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Soo Hee Kim
- Pathology Center, Seegene Medical Foundation, Seoul, Korea
| | - Hyo Song Kim
- Department of Internal Medicine, Division of Medical Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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14
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Chen TWW, Pang A, Puhaindran ME, Maw MM, Loong HH, Sriuranpong V, Chang CC, Mingmalairak S, Hirose T, Endo M, Kawai A, Farid M, Tan SH, Goh WL, Quek R, Chan JCH, Leung AKC, Ngan RKC. The treatment landscape of advanced angiosarcoma in Asia-A multi-national collaboration from the Asian Sarcoma Consortium. Cancer Sci 2021; 112:1095-1104. [PMID: 33393133 PMCID: PMC7935784 DOI: 10.1111/cas.14793] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 01/05/2023] Open
Abstract
Angiosarcoma (AS) is a rare disease with a dismal prognosis. The treatment landscape and prognostic factors for advanced AS, including locally advanced, unresectable, and metastatic disease remain elusive. The Asian Sarcoma Consortium is an international collaborative effort to understand the sarcoma treatment landscape in Asia. We undertook a retrospective chart review of AS patients seen in 8 sarcoma academic centers across Asia. Patients with complete clinical, treatment, and follow-up data were enrolled. Overall, 276 advanced AS patients were included into this study; 84 (30%) of the patients had metachronous metastatic AS. The median age was 67 y; primary sites of AS was cutaneous in 55% and visceral in 45% of patients. In total, 143 (52%) patients received at least 1 line of systemic chemotherapy. The most common first-line chemotherapy regimen used was paclitaxel (47.6%) followed by liposomal doxorubicin (19.6%). The median overall survival (OS) was 7.8 mo. Significant prognostic factors for OS included age > 65 (hazard ratio (HR) 1.54, P = .006), male gender (HR 1.39, P = .02), and a cutaneous primary AS site (HR 0.63, P = .004). The median progression-free survival (PFS) for first-line chemotherapy was 3.4 mo. PFS for single vs combination or paclitaxel vs liposomal doxorubicin chemotherapy regimens were comparable. This study provides an insight into the treatment patterns and prognostic factors of advanced AS patients in Asia. Prognosis of advanced AS remains poor. Data from this study serve as a benchmark for future clinical study design.
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Affiliation(s)
- Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan.,Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Angela Pang
- National University Cancer Institute, Singapore, National University Health System, Singapore City, Singapore
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore City, Singapore
| | - Myo Myint Maw
- Medical Oncology Unit, University of Medicine 1, Yangon, Myanmar
| | - Herbert H Loong
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong, China
| | - Virote Sriuranpong
- Division of Medical Oncology, Department of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Chih-Chi Chang
- Department of Cancer Administration and Coordination Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Siyamol Mingmalairak
- Division of Medical Oncology, Department of Medicine, Chulalongkorn University and the King Chulalongkorn Memorial Hospital, Bangkok, Thailand
| | - Takeshi Hirose
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Mohamad Farid
- Division of Medical Oncology, National Cancer Center, Singapore City, Singapore
| | - Sze Huey Tan
- Division of Clinical Trials and Epidemiological Sciences, National Cancer Center, Singapore City, Singapore.,Oncology Academic Clinical Programme, Duke-NUS Medical School, Singapore City, Singapore
| | - Wei Lin Goh
- Division of Medical Oncology, National Cancer Center, Singapore City, Singapore
| | - Richard Quek
- Parkway Cancer Centre Singapore, Singapore City, Singapore
| | - Jeffrey C H Chan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Alex K C Leung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China
| | - Roger K C Ngan
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong, China.,Department of Clinical Oncology, Queen Mary Hospital, Hong Kong, China
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15
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Saha J, Kim JH, Amaya CN, Witcher C, Khammanivong A, Korpela DM, Brown DR, Taylor J, Bryan BA, Dickerson EB. Propranolol Sensitizes Vascular Sarcoma Cells to Doxorubicin by Altering Lysosomal Drug Sequestration and Drug Efflux. Front Oncol 2021; 10:614288. [PMID: 33598432 PMCID: PMC7882688 DOI: 10.3389/fonc.2020.614288] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 12/14/2020] [Indexed: 01/02/2023] Open
Abstract
Angiosarcoma is a rare cancer of blood vessel-forming cells with a high patient mortality and few treatment options. Although chemotherapy often produces initial clinical responses, outcomes remain poor, largely due to the development of drug resistance. We previously identified a subset of doxorubicin-resistant cells in human angiosarcoma and canine hemangiosarcoma cell lines that exhibit high lysosomal accumulation of doxorubicin. Hydrophobic, weak base chemotherapeutics, like doxorubicin, are known to sequester within lysosomes, promoting resistance by limiting drug accessibility to cellular targets. Drug synergy between the beta adrenergic receptor (β-AR) antagonist, propranolol, and multiple chemotherapeutics has been documented in vitro, and clinical data have corroborated the increased therapeutic potential of propranolol with chemotherapy in angiosarcoma patients. Because propranolol is also a weak base and accumulates in lysosomes, we sought to determine whether propranolol enhanced doxorubicin cytotoxicity via antagonism of β-ARs or by preventing the lysosomal accumulation of doxorubicin. β-AR-like immunoreactivities were confirmed in primary tumor tissues and cell lines; receptor function was verified by monitoring downstream signaling pathways of β-ARs in response to receptor agonists and antagonists. Mechanistically, propranolol increased cytoplasmic doxorubicin concentrations in sarcoma cells by decreasing the lysosomal accumulation and cellular efflux of this chemotherapeutic agent. Equivalent concentrations of the receptor-active S-(-) and -inactive R-(+) enantiomers of propranolol produced similar effects, supporting a β-AR-independent mechanism. Long-term exposure of hemangiosarcoma cells to propranolol expanded both lysosomal size and number, yet cells remained sensitive to doxorubicin in the presence of propranolol. In contrast, removal of propranolol increased cellular resistance to doxorubicin, underscoring lysosomal doxorubicin sequestration as a key mechanism of resistance. Our results support the repurposing of the R-(+) enantiomer of propranolol with weak base chemotherapeutics to increase cytotoxicity and reduce the development of drug-resistant cell populations without the cardiovascular and other side effects associated with antagonism of β-ARs.
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Affiliation(s)
- Jhuma Saha
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Jong Hyuk Kim
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States.,Animal Cancer Care and Research Program, College of Veterinary Medicine University of Minnesota, St. Paul, MN, United States.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
| | - Clarissa N Amaya
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, United States.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Caleb Witcher
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX, United States
| | - Ali Khammanivong
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Derek M Korpela
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - David R Brown
- Department of Veterinary and Biomedical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States
| | - Josephine Taylor
- Department of Biology, Stephen F. Austin State University, Nacogdoches, TX, United States
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, United States.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, United States
| | - Erin B Dickerson
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, MN, United States.,Animal Cancer Care and Research Program, College of Veterinary Medicine University of Minnesota, St. Paul, MN, United States.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, United States
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16
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Chen TWW, Burns J, Jones RL, Huang PH. Optimal Clinical Management and the Molecular Biology of Angiosarcomas. Cancers (Basel) 2020; 12:E3321. [PMID: 33182685 PMCID: PMC7696056 DOI: 10.3390/cancers12113321] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 12/12/2022] Open
Abstract
Angiosarcomas comprise less than 3% of all soft tissue sarcomas but have a poor prognosis. Most angiosarcomas occur without obvious risk factors but secondary angiosarcoma could arise after radiotherapy or chronic lymphedema. Surgery remains the standard treatment for localized angiosarcoma but neoadjuvant systemic treatment may improve the curability. For advanced angiosarcoma, anthracyclines and taxanes are the main chemotherapy options. Anti-angiogenic agents have a substantial role but the failure of a randomized phase 3 trial of pazopanib with or without an anti-endoglin antibody brings a challenge to future trials in angiosarcomas. Immune checkpoint inhibitors as single agents or in combination with oncolytic virus may play an important role but the optimal duration remains to be investigated. We also report the current understanding of the molecular pathways involved in angiosarcoma pathogenesis including MYC amplification, activation of angiogenic pathways and different molecular alterations that are associated with angiosarcomas of different aetiology. The success of the patient-partnered Angiosarcoma Project (ASCProject) has provided not only detailed insights into the molecular features of angiosarcomas of different origins but also offers a template for future fruitful collaborations between patients, physicians, and researchers. Lastly, we provide our perspective of future developments in optimizing the clinical management of angiosarcomas.
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Affiliation(s)
- Tom Wei-Wu Chen
- Department of Oncology, National Taiwan University Hospital and Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei 100, Taiwan
| | - Jessica Burns
- Division of Molecular Pathology, The Institute of Cancer Research, London SW3 6JB, UK;
| | - Robin L. Jones
- Sarcoma Unit, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London SW3 6JJ, UK;
| | - Paul H. Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London SW3 6JB, UK;
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17
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Wu M, Huang Y, Tian W, Yao Y, Deng Y. Recurrence of Primary Breast Angiosarcoma 7 Years after Mastectomy in a 17-Year-Old Woman: A Case Report. Breast Care (Basel) 2019; 14:330-333. [PMID: 31798394 DOI: 10.1159/000493881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background Primary breast angiosarcoma is a rare neoplasm; breast angiosarcoma patients under 20 years old are extremely rare. The prognosis is often poor due to a high relapse rate after surgical resection. Case Report We report on a case of a 17-year-old woman suffering from a primary breast angiosarcoma, associated with the local recurrence of a right-breast angiosarcoma 86 months after mastectomy. She received extensive local excision and transplantation of an adjacent skin flap. The post-operation diagnosis was angiosarcoma of histological grade III. Conclusions This is a rare case as the patient was below 18 years old and the follow-up was greater than 5 years. Taken together, long-term close follow-up is extremely important, regardless of how long after surgery and the status of the surgical margins.
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Affiliation(s)
- Miaowei Wu
- Department of Surgical Oncology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yajing Huang
- Department of Pathology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Wei Tian
- Department of Surgical Oncology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yihan Yao
- Department of Surgical Oncology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yongchuan Deng
- Department of Surgical Oncology, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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18
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Borgatti A, Dickerson EB, Lawrence J. Emerging therapeutic approaches for canine sarcomas: Pushing the boundaries beyond the conventional. Vet Comp Oncol 2019; 18:9-24. [PMID: 31749286 DOI: 10.1111/vco.12554] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 11/08/2019] [Accepted: 11/11/2019] [Indexed: 12/21/2022]
Abstract
Sarcomas represent a group of genomically chaotic, highly heterogenous tumours of mesenchymal origin with variable mutational load. Conventional therapy with surgery and radiation therapy is effective for managing small, low-grade sarcomas and remains the standard therapeutic approach. For advanced, high-grade, recurrent, or metastatic sarcomas, systemic chemotherapy provides minimal benefit, therefore, there is a drive to develop novel approaches. The discovery of "Coley's toxins" in the 19th century, and their use to stimulate the immune system supported the application of unconventional therapies for the treatment of sarcomas. While promising, this initial work was abandoned and treatment paradigm and disease course of sarcomas was largely unchanged for several decades. Exciting new therapies are currently changing treatment algorithms for advanced carcinomas and melanomas, and similar approaches are being applied to advance the field of sarcoma research. Recent discoveries in subtype-specific cancer biology and the identification of distinct molecular targets have led to the development of promising targeted strategies with remarkable potential to change the landscape of sarcoma therapy in dogs. The purpose of this review article is to describe the current standard of care and limitations as well as emerging approaches for sarcoma therapy that span many of the most active paradigms in oncologic research, including immunotherapies, checkpoint inhibitors, and drugs capable of cellular metabolic reprogramming.
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Affiliation(s)
- Antonella Borgatti
- Animal Cancer Care and Research (ACCR) Program, University of Minnesota, St. Paul, Minnesota.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota.,Clinical Investigation Center, College of Veterinary Medicine, St. Paul, Minnesota
| | - Erin B Dickerson
- Animal Cancer Care and Research (ACCR) Program, University of Minnesota, St. Paul, Minnesota.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Jessica Lawrence
- Animal Cancer Care and Research (ACCR) Program, University of Minnesota, St. Paul, Minnesota.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St. Paul, Minnesota.,Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
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19
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Cao J, Wang J, He C, Fang M. Angiosarcoma: a review of diagnosis and current treatment. Am J Cancer Res 2019; 9:2303-2313. [PMID: 31815036 PMCID: PMC6895451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 10/03/2019] [Indexed: 06/10/2023] Open
Abstract
Angiosarcoma is a highly malignancy of endothelial tumor and represents 1-2% of all soft tissue sarcomas in humans. The aetiology of angiosarcoma is not clear but there are definite risk factors including chronic lymphoedema, history of radiation, environmental carcinogens and certain familial syndromes. Ultrasound, CT and MR are diagnostic tools, but final diagnosis requires pathological and immunohistochemical confirmation. The conventional options of treatment include surgery, radiotherapy and chemotherapy. Targeted medicines and immunotherapy have been studied as promising treatment of angiosarcoma. The goal of this review is to summarize the current data regarding of angiosarcoma and its clinical presentation and management, providing a useful clinical tool to explore the optimal treatment.
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Affiliation(s)
- Jun Cao
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
| | - Jiale Wang
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Chiyu He
- Second Clinical Medical College, Zhejiang Chinese Medical UniversityHangzhou, Zhejiang, China
| | - Meiyu Fang
- Department of Comprehensive Medical Oncology, Key Laboratory of Head and Neck Cancer Translational Research of Zhejiang Province, Cancer Hospital of University of Chinese Academy of Sciences, Zhejiang Cancer HospitalHangzhou, Zhejiang, China
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20
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Wilding CP, Elms ML, Judson I, Tan AC, Jones RL, Huang PH. The landscape of tyrosine kinase inhibitors in sarcomas: looking beyond pazopanib. Expert Rev Anticancer Ther 2019; 19:971-991. [PMID: 31665941 PMCID: PMC6882314 DOI: 10.1080/14737140.2019.1686979] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 10/28/2019] [Indexed: 02/06/2023]
Abstract
Introduction: Tyrosine kinases are key mediators of intracellular signaling cascades and aberrations in these proteins have been implicated in driving oncogenesis through the dysregulation of fundamental cellular processes including proliferation, migration, and apoptosis. As such, targeting these proteins with small molecule tyrosine kinase inhibitors (TKI) has led to significant advances in the treatment of a number of cancer types.Areas covered: Soft tissue sarcomas (STS) are a heterogeneous and challenging group of rare cancers to treat, but the approval of the TKI pazopanib for the treatment of advanced STS demonstrates that this class of drugs may have broad utility against a range of different sarcoma histological subtypes. Since the approval of pazopanib, a number of other TKIs have entered clinical trials to evaluate whether their activity in STS matches the promising results seen in other solid tumors. In this article, we review the emerging role of TKIs in the evolving landscape of sarcoma treatment.Expert opinion: As our biological understanding of response and resistance of STS to TKIs advances, we anticipate that patient management will move away from a 'one size fits all' paradigm toward personalized, multi-line, and patient-specific treatment regimens where patients are treated according to the underlying biology and genetics of their specific disease.
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Affiliation(s)
| | - Mark L Elms
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Ian Judson
- Department of Medical Oncology, Sarcoma Unit, The Royal Marsden Hospital, London, UK
| | - Aik-Choon Tan
- Department of Biostatistics and Bioinformatics, Moffitt Cancer Center, Tampa, FL, USA
| | - Robin L Jones
- Department of Medical Oncology, Sarcoma Unit, The Royal Marsden Hospital, London, UK
| | - Paul H Huang
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
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21
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Matos GDR, de Camargo VP, Munhoz RR, de Castro G. Non-gastrointestinal stromal tumours soft tissue sarcomas: an update. Ecancermedicalscience 2019; 13:958. [PMID: 31645886 PMCID: PMC6759358 DOI: 10.3332/ecancer.2019.958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Indexed: 11/21/2022] Open
Abstract
Soft tissue sarcomas (STS) encompass a diverse family of neoplasms of mesenchymal origin, marked by significant heterogeneity in terms of physiopathology, molecular characterisation, natural history and response to different therapies. This review aims to summarise the current strategies for the management of patients with STS, including surgery, systemic treatments and radiation therapy, along with considerations applicable to the most frequent subtypes, as well as particularities associated with less common and specific histologies. It also provides insights into upcoming strategies to tackle this challenging group of diseases.
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Affiliation(s)
- Gustavo Duarte Ramos Matos
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,https://orcid.org/0000-0002-0681-4975
| | - Veridiana Pires de Camargo
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Onco Star São Luiz Rede D'Or, São Paulo 04544-000, Brazil
| | - Rodrigo Ramella Munhoz
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Hospital Sírio-Libanês, São Paulo 01308-050, Brazil
| | - Gilberto de Castro
- Instituto do Câncer do Estado de São Paulo, São Paulo 01246-000, Brazil.,Hospital Sírio-Libanês, São Paulo 01308-050, Brazil.,https://orcid.org/0000-0001-8765-3044
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22
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Bönisch N, Langan EA, Terheyden P. [Cutaneous angiosarcoma : Radiochemotherapy with liposomal pegylated doxorubicin]. Hautarzt 2019; 70:700-706. [PMID: 31428802 DOI: 10.1007/s00105-019-4462-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Whilst cutaneous angiosarcoma is rare tumour which primarily affects elderly patients, its management presents a significant therapeutic challenge. Indeed, complete surgical excision is often not possible due to the location and the diffuse and extensive nature of the tumour. Therefore, current treatment strategies often include chemo- and/or radiotherapy. METHODS We report our experience of combined chemo- and radiotherapy in the clinical course of 6 patients with cutaneous angiosarcoma who were treated between 2007 and 2018. RESULTS All patients presented non-resectable tumours and were treated with radiotherapy in combination with the administration of liposomal, pegylated doxrubicin (25 mg/m2 every 2 weeks). The mean duration of progression-free survival was 8 months (5-14 months), corresponding to an overall survival of 13 months (13-34 months). A partial response was seen in 4 patients and 1 patient developed progressive disease. One patient abandoned therapy after one administration. Two patients developed severe adverse events which led to termination of therapy after 1.5 months and 7 months, i.e. after 4 and 15 cycles respectively. DISCUSSION Combined radio- and chemotherapy with liposomal, pegylated doxorubicin is a useful therapeutic option in the management of cutaneous angiosarcoma. Given the short-lived response rate, new treatment options are urgently required.
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Affiliation(s)
- N Bönisch
- Klinik für Dermatologie, Universität zu Lübeck, Lübeck, Deutschland
| | - E A Langan
- Klinik für Dermatologie, Universität zu Lübeck, Lübeck, Deutschland.,Dermatological Science, University of Manchester, Manchester, Großbritannien
| | - P Terheyden
- Klinik für Dermatologie, Allergologie und Venerologie, Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
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23
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Bernstock JD, Shafaat O, Hardigan A, Fox BM, Moore LS, Chagoya G, Elsayed G, Gessler F, Ilyas A, Yamashita D, McGrew B, Fisher WS, Hackney J, Sotoudeh H. Angiosarcoma of the Temporal Bone: Case Report and Review of the Literature. World Neurosurg 2019; 130:351-357. [PMID: 31330332 DOI: 10.1016/j.wneu.2019.07.107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Revised: 07/11/2019] [Accepted: 07/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Angiosarcomas are rare malignant tumors of endothelial origin. Nearly one half of all angiosarcomas occur in the head and neck. Temporal bone angiosarcomas are extremely uncommon. We present a case of temporal bone angiosarcoma and a review of the relevant data. CASE DESCRIPTION We present the case of a 20-year-old man with a painful right postauricular mass after a closed head injury. Radiologic studies demonstrated a large right osteolytic and heterogeneously enhancing mass. The patient underwent right transpetrosal craniectomy for resection. Histologic studies confirmed high-grade sarcoma. Immunohistochemical staining demonstrated a uniformly positive ERG endothelial marker, CD31 staining with cytoplasmic and membranous patterns of immunopositivity, positive nuclear staining for FLI-1, positive cytoplasmic and membranous staining for CD99 and STAT6, and negative smooth muscle actin stains in the neoplastic cells. Ki-67 staining showed ∼94% positivity in the neoplastic cell nuclei. Postoperative follow-up imaging studies demonstrated evidence of metastatic right cervical lymphadenopathy. CONCLUSIONS Angiosarcoma of the temporal bone is extremely uncommon. In the present case report, we explored a relationship between trauma and angiosarcoma of the temporal bone. We reviewed the reported data regarding the pathogenesis, diagnosis, treatment, radiologic findings, and histologic characteristics of angiosarcoma of the temporal bone.
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Affiliation(s)
- Joshua D Bernstock
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Omid Shafaat
- Department of Radiology and Interventional Neuroradiology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Andrew Hardigan
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Brandon M Fox
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Lindsay S Moore
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Gustavo Chagoya
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Galal Elsayed
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Florian Gessler
- Department of Neurosurgery, Goethe University Hospital, Frankfurt, Germany
| | - Adeel Ilyas
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Daisuke Yamashita
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Benjamin McGrew
- Department of Otolaryngology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Winfield S Fisher
- Department of Neurosurgery, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - James Hackney
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Houman Sotoudeh
- Department of Neuroradiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
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24
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Wagner MJ, Cranmer LD, Loggers ET, Pollack SM. Propranolol for the treatment of vascular sarcomas. J Exp Pharmacol 2018; 10:51-58. [PMID: 30233257 PMCID: PMC6130307 DOI: 10.2147/jep.s146211] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Vascular sarcomas are abnormal proliferations of endothelial cells. They range from benign hemangioma to aggressive angiosarcoma, and are characterized by dysregulated angiogenic signaling. Propranolol is a β-adrenergic receptor inhibitor that has demonstrated clinical efficacy in benign infantile hemangioma, and is now being used experimentally for more aggressive vascular sarcomas and other cancers. In this review, we discuss the use of propranolol in targeting these receptors in vascular tumors and other cancers.
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Affiliation(s)
- Michael J Wagner
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Lee D Cranmer
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Elizabeth T Loggers
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
| | - Seth M Pollack
- Division of Medical Oncology, .,Clinical Research Division University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA,
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25
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Amaya CN, Perkins M, Belmont A, Herrera C, Nasrazadani A, Vargas A, Khayou T, Montoya A, Ballou Y, Galvan D, Rivas A, Rains S, Patel L, Ortega V, Lopez C, Chow W, Dickerson EB, Bryan BA. Non-selective beta blockers inhibit angiosarcoma cell viability and increase progression free- and overall-survival in patients diagnosed with metastatic angiosarcoma. Oncoscience 2018; 5:109-119. [PMID: 29854879 PMCID: PMC5978448 DOI: 10.18632/oncoscience.413] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/02/2018] [Indexed: 12/18/2022] Open
Abstract
Patients with metastatic angiosarcoma undergoing chemotherapy, radiation, and/or surgery experience a median progression free survival of less than 6 months and a median overall survival of less than 12 months. Given the aggressive nature of this cancer, angiosarcoma clinical responses to chemotherapy or targeted therapeutics are generally very poor. Inhibition of beta adrenergic receptor (β-AR) signaling has recently been shown to decrease angiosarcoma tumor cell viability, abrogate tumor growth in mouse models, and decrease proliferation rates in preclinical and clinical settings. In the current study we used cell and animal tumor models to show that β-AR antagonism abrogates mitogenic signaling and reduces angiosarcoma tumor cell viability, and these molecular alterations translated into patient tumors. We demonstrated that non-selective β-AR antagonists are superior to selective β-AR antagonists at inhibiting angiosarcoma cell viability. A prospective analysis of non- selective β-AR antagonists in a single arm clinical study of metastatic angiosarcoma patients revealed that incorporation of either propranolol or carvedilol into patients' treatment regimens leads to a median progression free and overall survival of 9 and 36 months, respectively. These data suggest that incorporation of non-selective β-AR antagonists into existing therapies against metastatic angiosarcoma can enhance clinical outcomes.
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Affiliation(s)
- Clarissa N Amaya
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Mariah Perkins
- Department of Biochemistry, Baylor University, Waco, TX, USA
| | - Andres Belmont
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Connie Herrera
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Arezo Nasrazadani
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alejandro Vargas
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Thuraieh Khayou
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alexa Montoya
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA.,Department of Biology, University of Texas, El Paso, TX, USA
| | - Yessenia Ballou
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Dana Galvan
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Alexandria Rivas
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Steven Rains
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Luv Patel
- Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Vanessa Ortega
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - Christopher Lopez
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - William Chow
- Mohs Micrographic Surgery and Cutaneous Oncology, San Leandro, CA, USA
| | - Erin B Dickerson
- Department of Veterinary Clinical Sciences, University of Minnesota, St. Paul, MN, USA.,Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA
| | - Brad A Bryan
- Department of Biomedical Sciences, Texas Tech University Health Sciences Center, El Paso, TX, USA.,Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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26
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Dogan A, Kern P, Schultheis B, Häusler G, Rezniczek GA, Tempfer CB. Radiogenic angiosarcoma of the breast: case report and systematic review of the literature. BMC Cancer 2018; 18:463. [PMID: 29690864 PMCID: PMC5916720 DOI: 10.1186/s12885-018-4369-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Accepted: 04/15/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Radiogenic angiosarcoma of the breast (RASB) is a rare late sequela of local irradiation of the breast or chest wall after breast cancer. The prognosis of women with RASB is poor and there is no standardized therapy for this type of malignancy. CASE PRESENTATION We present the case of a 54 year old woman with RASB (poorly differentiated angiosarcoma of the left breast; pT1, pNX, M0, L0, V0) and a history of invasive-ductal cancer of the left breast (pT1b, G2, pN0, ER positive, PR positive, HER-2/neu negative) treated in July 2012 with breast-conserving surgery, adjuvant chemotherapy with 6 cycles of epirubicin and cyclophosphamide, adjuvant irradiation of the left breast with 50 Gray, and adjuvant endocrine therapy with an aromatase inhibitor. In August 2016, a bilateral salpingo-oophorectomy was performed to remove a tumor of the left ovary, which was diagnosed as breast cancer recurrence. At the same time, a small, purple skin lesion of 1.2 cm in diameter was noted in the inner upper quadrant of the right breast. RASB was diagnosed by punch biopsy and the tumor was excised with clear margins. Imaging studies showed no evidence of further metastases. A systemic chemotherapy with 6 cycles of liposomal doxorubicin was initiated. Five months later, a local recurrence of RASB was diagnosed and mastectomy was performed. Six months later, the patient is alive with no evidence of disease. Three hundred seven cases of RASB were identified. The pooled incidence rate of RASB was 1/3754 women. The most common treatment of RASB was mastectomy in 83% of cases. Adjuvant radiotherapy or chemotherapy were rarely used with 6 and 4%, respectively, whereas in case of recurrence, chemotherapy was the mainstay of treatment, used in 58% of cases. Radiotherapy and repeated surgery were also common with 30 and 33% of cases, respectively. Overall, the prognosis of women with RASB was poor and the recurrence-free survival was short with a mean of 15.9 months. Mean overall survival was 27.4 months. CONCLUSION RASB is a rare late complication of breast irradiation. The prognosis of women with RASB is poor. Surgery is the mainstay of treatment for localized disease while systemic chemotherapy and re-irradiation are appropriate for women with disseminated or recurrent RASB.
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Affiliation(s)
- Askin Dogan
- Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany
| | - Peter Kern
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital, Bochum, Germany
| | - Beate Schultheis
- Department of Hematology and Oncology, Ruhr-Universität Bochum, Bochum, Germany
| | - Günther Häusler
- Karl Landsteiner Institute of Gynecological Diagnostics & Therapy, Mauerbach, Austria
| | - Günther A Rezniczek
- Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany
| | - Clemens B Tempfer
- Department of Obstetrics and Gynecology, Ruhr-Universität Bochum, Bochum, Germany.
- Karl Landsteiner Institute of Gynecological Diagnostics & Therapy, Mauerbach, Austria.
- Department of Obstetrics and Gynecology, Ruhr-Universität Bochum - Marien Hospital Herne, Hölkeskampring 40, 44625, Herne, Germany.
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27
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Abstract
OPINION STATEMENT Angiosarcomas are rare vascular neoplasms that are among the most aggressive subtypes of soft tissue sarcomas. Surgical resection is often challenging even in localized disease, as the infiltrative nature of these cancers leads to frequent local and metastatic recurrences. Cytotoxic chemotherapy, including anthracycline-based regimens and taxanes can produce significant responses in a subset of patients but durability is limited with most patients ultimately succumbing to metastatic disease. Targeted therapy with tyrosine kinase inhibitors is usually well-tolerated but prone to development of resistance. Few head-to-head trials have addressed the optimal sequence of therapies, or demonstrated conclusive benefits of one therapy over another based on clinical and etiologic factors. Novel therapies in clinical trials, including antibodies to endoglin and checkpoint inhibitors have demonstrated exciting early activity in patients with angiosarcoma. Improved understanding of the genetic heterogeneity within various angiosarcoma subtypes may identify predictive biomarkers to match patients to effective existing and future therapies. Overall, angiosarcoma patients with optimal performance status are best served in clinical trials that incorporate novel combinations of cytotoxic chemotherapy, targeted therapies, and immunotherapies.
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28
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Venkataramani V, Küffer S, Cheung KCP, Jiang X, Trümper L, Wulf GG, Ströbel P. CD31 Expression Determines Redox Status and Chemoresistance in Human Angiosarcomas. Clin Cancer Res 2017; 24:460-473. [PMID: 29084920 DOI: 10.1158/1078-0432.ccr-17-1778] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 09/14/2017] [Accepted: 10/23/2017] [Indexed: 12/28/2022]
Abstract
Purpose: Angiosarcomas are soft tissue sarcomas with endothelial differentiation and vasoformative capacity. Most angiosarcomas show strong constitutive expression of the endothelial adhesion receptor CD31/PECAM-1 pointing to an important role of this molecule. However, the biological function of CD31 in angiosarcomas is unknown.Experimental Design: The expression levels of CD31 in angiosarcoma cells and its effects on cell viability, colony formation, and chemoresistance were evaluated in human angiosarcoma clinical samples and in cell lines through isolation of CD31high and CD31low cell subsets. The redox-regulatory CD31 function linked to YAP signaling was determined using a CD31-blocking antibody and siRNA approach and was further validated in CD31-knockout endothelial cells.Results: We found that most angiosarcomas contain a small CD31low cell population. CD31low cells had lost part of their endothelial properties and were more tumorigenic and chemoresistant than CD31high cells due to more efficient reactive oxygen species (ROS) detoxification. Active downregulation of CD31 resulted in loss of endothelial tube formation, nuclear accumulation of YAP, and YAP-dependent induction of antioxidative enzymes. Addition of pazopanib, a known enhancer of proteasomal YAP degradation resensitized CD31low cells for doxorubicin resulting in growth suppression and induction of apoptosis.Conclusions: Human angiosarcomas contain a small aggressive CD31low population that have lost part of their endothelial differentiation programs and are more resistant against oxidative stress and DNA damage due to intensified YAP signaling. Our finding that the addition of YAP inhibitors can resensitize CD31low cells toward doxorubicin may aid in the rational development of novel combination therapies to treat angiosarcomas. Clin Cancer Res; 24(2); 460-73. ©2017 AACR.
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Affiliation(s)
- Vivek Venkataramani
- Department of Hematology and Medical Oncology, University Medical Center Göttingen (UMG), Göttingen, Germany. .,Cell Biology Program, Memorial Sloan Kettering Cancer Center, Göttingen, Germany
| | - Stefan Küffer
- Institute of Pathology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Kenneth C P Cheung
- William Harvey Research Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Xuejun Jiang
- Cell Biology Program, Memorial Sloan Kettering Cancer Center, Göttingen, Germany
| | - Lorenz Trümper
- Department of Hematology and Medical Oncology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Gerald G Wulf
- Department of Hematology and Medical Oncology, University Medical Center Göttingen (UMG), Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen (UMG), Göttingen, Germany
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29
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Botti G, Scognamiglio G, Marra L, Pizzolorusso A, Di Bonito M, De Cecio R, Cantile M, De Chiara A. Programmed Death Ligand 1 (PD-L1) Expression in Primary Angiosarcoma. J Cancer 2017; 8:3166-3172. [PMID: 29158788 PMCID: PMC5665032 DOI: 10.7150/jca.19060] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/31/2017] [Indexed: 12/29/2022] Open
Abstract
Angiosarcomas are rare malignant endothelial-cell tumors of vascular or lymphatic origin, and are among the most aggressive subtypes of soft-tissue sarcomas. The prognosis is poor and treatment is challenging in many cases. PD-1/PD-L1 pathway plays a critical role in immune escape of tumor cells. Recent studies described that PD-L1 is widely expressed in various types of cancer, providing the basis for the development of PD1/PD-L1 antibodies as anti-cancer immunotherapy. Despite the well-known potential of PD-L1 as prognostic and predictive biomarker, only few studies described its IHC expression in cancer subtypes for the extreme difficulty in developing standard protocol with the different antibody clones available. We analyzed the IHC expression of PD-L1 on a series of angiosarcomas at different body location, showing its aberrant expression in about 66% of samples with no relation with prognosis. Our study allowed us to correctly define PD-L1 staining in angiosarcoma tumor tissues with final purpose to stratify patients for immune checkpoint inhibitors therapies.
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Affiliation(s)
- Gerardo Botti
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Giosuè Scognamiglio
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Laura Marra
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Antonio Pizzolorusso
- Department of Muscle-skeletal Oncology, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Maurizio Di Bonito
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Rossella De Cecio
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Monica Cantile
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
| | - Annarosaria De Chiara
- Pathology Unit, Istituto Nazionale Tumori Fondazione "G. Pascale", via Mariano Semmola, 80131 Napoli, Italy
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30
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Hanna JA, Drummond CJ, Garcia MR, Go JC, Finkelstein D, Rehg JE, Hatley ME. Biallelic Dicer1 Loss Mediated by aP2-Cre Drives Angiosarcoma. Cancer Res 2017; 77:6109-6118. [PMID: 28916654 DOI: 10.1158/0008-5472.can-17-1262] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/11/2017] [Accepted: 09/12/2017] [Indexed: 12/14/2022]
Abstract
Angiosarcoma is an aggressive vascular sarcoma with an extremely poor prognosis. Because of the relative rarity of this disease, its molecular drivers and optimal treatment strategies are obscure. DICER1 is an RNase III endoribonuclease central to miRNA biogenesis, and germline DICER1 mutations result in a cancer predisposition syndrome, associated with an increased risk of many tumor types. Here, we show that biallelic Dicer1 deletion with aP2-Cre drives aggressive and metastatic angiosarcoma independent of other genetically engineered oncogenes or tumor suppressor loss. Angiosarcomas in aP2-Cre;Dicer1Flox/- mice histologically and genetically resemble human angiosarcoma. miR-23 target genes, including the oncogenes Ccnd1 as well as Adam19, Plau, and Wsb1 that promote invasiveness and metastasis, were enriched in mouse and human angiosarcoma. These studies illustrate that Dicer1 can function as a traditional loss-of-function tumor suppressor gene, and they provide a fully penetrant animal model for the study of angiosarcoma development and metastasis. Cancer Res; 77(22); 6109-18. ©2017 AACR.
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Affiliation(s)
- Jason A Hanna
- Department of Oncology, Molecular Oncology Division, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Catherine J Drummond
- Department of Oncology, Molecular Oncology Division, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Matthew R Garcia
- Department of Oncology, Molecular Oncology Division, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jonathan C Go
- Department of Oncology, Molecular Oncology Division, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - David Finkelstein
- Department of Computational Biology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Jerold E Rehg
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee
| | - Mark E Hatley
- Department of Oncology, Molecular Oncology Division, St. Jude Children's Research Hospital, Memphis, Tennessee.
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Abstract
Soft tissue sarcomas are rare tumors that present with distant metastasis in up to 10% of patients. Survival has improved significantly because of advancements in histologic classification and improved management approaches. Older agents such as doxorubicin, ifosfamide, gemcitabine, and paclitaxel continue to demonstrate objective response rates from 18% to 25%. Newer agents such as trabectedin, eribulin, aldoxorubicin, and olaratumab have demonstrated improvements in progression-free survival, overall survival, or toxicity profiles. Future studies on treatment of advanced soft tissue sarcoma will continue to concentrate on reducing toxicity, personalization of therapy, and targeting novel pathways.
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Affiliation(s)
- Jennifer Y Sheng
- Department of Oncology, Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
| | - Sujana Movva
- Department of Hematology/Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA
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Mota JM, Scaranti M, Fonseca LG, Tolói DA, de Camargo VP, Munhoz RR, Feher O, Hoff PM. Response to Paclitaxel in an Adult Patient with Advanced Kaposiform Hemangioendothelioma. Case Rep Oncol 2016; 9:481-487. [PMID: 27721772 PMCID: PMC5043218 DOI: 10.1159/000448111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 07/01/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Kaposiform hemangioendothelioma (KHE) is a rare neoplasm of vascular origin that typically arises from the skin or soft tissues as a solitary tumor. The optimal therapy for this disease is still unknown. We report the case of an adult patient presenting with metastatic KHE of the spleen, who had a partial response after treatment with paclitaxel. CASE PRESENTATION A 36-year-old man presented in November 2012 with a nontraumatic rupture of the spleen. A splenectomy was performed, and the pathology was consistent with a nonspecific vascular proliferation. Follow-up scans revealed lytic bone lesions and liver metastasis. A biopsy of the liver was performed and confirmed KHE. The decision was made to proceed with treatment with gemcitabine and docetaxel, which was discontinued due to myelotoxicity. The patient was then transferred to our institution, and a pathology review supported the diagnosis of metastatic KHE. His disease remained stable until February 2014, when he developed progression in the liver. Chemotherapy was restarted with paclitaxel, and a partial response was documented after 3 cycles. Unfortunately, disease progression occurred after 24 weeks, and subsequent treatments included prednisone, doxorubicin, interferon-α, gemcitabine, and ifosfamide, without any response. The patient developed Kasabach-Merritt phenomenon and passed away 1 week later due to a major gastrointestinal bleeding. CONCLUSIONS This case report suggests that paclitaxel could be considered as a treatment option for advanced KHE, a rare condition for which no standard treatment exists.
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Affiliation(s)
- José Maurício Mota
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Mariana Scaranti
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Leonardo G Fonseca
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Diego Araújo Tolói
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Veridiana Pires de Camargo
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Rodrigo Ramella Munhoz
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Olavo Feher
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M Hoff
- Medical Oncology Division, Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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33
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Dickson MA, Mahoney MR, Tap WD, D'Angelo SP, Keohan ML, Van Tine BA, Agulnik M, Horvath LE, Nair JS, Schwartz GK. Phase II study of MLN8237 (Alisertib) in advanced/metastatic sarcoma. Ann Oncol 2016; 27:1855-60. [PMID: 27502708 DOI: 10.1093/annonc/mdw281] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 07/08/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Aurora kinase A (AURKA) is commonly overexpressed in sarcoma. The inhibition of AURKA by shRNA or by a specific AURKA inhibitor blocks in vitro proliferation of multiple sarcoma subtypes. MLN8237 (alisertib) is a novel oral adenosine triphosphate-competitive AURKA inhibitor. PATIENTS AND METHODS This Cancer Therapy Evaluation Program-sponsored phase II study of alisertib was conducted through the Alliance for Clinical Trials in Oncology (A091102). Patients were enrolled into histology-defined cohorts: (i) liposarcoma, (ii) leiomyosarcoma, (iii) undifferentiated sarcoma, (iv) malignant peripheral nerve sheath tumor, or (v) other. Treatment was alisertib 50 mg PO b.i.d. d1-d7 every 21 days. The primary end point was response rate; progression-free survival (PFS) was secondary. One response in the first 9 patients expanded enrollment in a cohort to 24 using a Simon two-stage design. RESULTS Seventy-two patients were enrolled at 24 sites [12 LPS, 10 LMS, 11 US, 10 malignant peripheral nerve sheath tumor (MPNST), 29 Other]. The median age was 55 years; 54% were male; 58%/38%/4% were ECOG PS 0/1/2. One PR expanded enrollment to the second stage in the other sarcoma cohort. The histology-specific cohorts ceased at the first stage. There were two confirmed PRs in the other cohort (both angiosarcoma) and one unconfirmed PR in dedifferentiated chondrosarcoma. Twelve-week PFS was 73% (LPS), 44% (LMS), 36% (US), 60% (MPNST), and 38% (Other). Grade 3-4 adverse events: oral mucositis (12%), anemia (14%), platelet count decreased (14%), leukopenia (22%), and neutropenia (42%). CONCLUSIONS Alisertib was well tolerated. Occasional responses, yet prolonged stable disease, were observed. Although failing to meet the primary RR end point, PFS was promising. TRIAL REGISTRATION ID NCT01653028.
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Affiliation(s)
- M A Dickson
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M R Mahoney
- Biomedical Statistics & Informatics, Alliance Statistics and Data Center, Mayo Clinic, Rochester
| | - W D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - S P D'Angelo
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - M L Keohan
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York Weill Cornell Medical College, New York
| | - B A Van Tine
- Department of Internal Medicine, Washington University School of Medicine, Saint Louis
| | - M Agulnik
- Department of Hematology and Oncology, Northwestern University, Chicago
| | - L E Horvath
- Department of Medicine, Alliance for Clinical Trials in Oncology, Chicago
| | - J S Nair
- Department of Medicine, Columbia University Medical Center, New York, USA
| | - G K Schwartz
- Department of Medicine, Columbia University Medical Center, New York, USA
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