Real-World Clinical Outcomes and Prognostic Factors for Patients with Advanced Angiosarcoma who Received Systemic Treatment
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose Angiosarcoma is a highly aggressive mesenchymal tumor. Although systemic chemotherapy is often considered for the inoperable or metastatic angiosarcoma, the outcome of such treatment is unsatisfactory and poorly delineated. Materials and Methods We reviewed electronic medical records of 75 patients with angiosarcoma who were treated with systemic chemotherapy for inoperable or metastatic disease. Patients were classified as having liver involvement if they had either primary or metastatic hepatic lesions. Results Among the patients evaluated, 51 patients (68%) were male and 24 patients (32%) had primary cutaneous angiosarcoma. Liver involvement was present in 28 patients (37.3%). A total of 59 patients received first-line weekly paclitaxel (wPac) and showed an objective response rate (ORR) of 23.7% (n=14), a median progression-free survival (mPFS) of 4.0 months (95% confidence interval [CI], 3.0 to 6.1), and a median overall survival (mOS) of 10.2 months (95% CI, 7.0 to 14.6). Among patients without liver involvement, patients receiving wPac (n=35) had significantly prolonged mPFS (5.8 months vs. 3.2 months, respectively; p=0.014) with a tendency for prolonged mOS (13.8 months vs. 11.6 months, respectively; p=0.13) than those receiving other regimens (n=12). A total of 24 patients received second- or later-line pazopanib monotherapy and showed an ORR of 16.7% (n=4), a mPFS of 2.4 months (95% CI, 1.8 to 4.3) and a mOS of 5.4 months (95% CI, 3.5 to not available). Conclusion Treatment with first-line wPac and later-line pazopanib seems to provide survival benefit, especially for patients with advanced angiosarcoma without liver involvement.
Abstract
Purpose Angiosarcoma is a highly aggressive mesenchymal tumor. Although systemic chemotherapy is often considered for the inoperable or metastatic angiosarcoma, the outcome of such treatment is unsatisfactory and poorly delineated. Materials and Methods We reviewed electronic medical records of 75 patients with angiosarcoma who were treated with systemic chemotherapy for inoperable or metastatic disease. Patients were classified as having liver involvement if they had either primary or metastatic hepatic lesions. Results Among the patients evaluated, 51 patients (68%) were male and 24 patients (32%) had primary cutaneous angiosarcoma. Liver involvement was present in 28 patients (37.3%). A total of 59 patients received first-line weekly paclitaxel (wPac) and showed an objective response rate (ORR) of 23.7% (n=14), a median progression-free survival (mPFS) of 4.0 months (95% confidence interval [CI], 3.0 to 6.1), and a median overall survival (mOS) of 10.2 months (95% CI, 7.0 to 14.6). Among patients without liver involvement, patients receiving wPac (n=35) had significantly prolonged mPFS (5.8 months vs. 3.2 months, respectively; p=0.014) with a tendency for prolonged mOS (13.8 months vs. 11.6 months, respectively; p=0.13) than those receiving other regimens (n=12). A total of 24 patients received second- or later-line pazopanib monotherapy and showed an ORR of 16.7% (n=4), a mPFS of 2.4 months (95% CI, 1.8 to 4.3) and a mOS of 5.4 months (95% CI, 3.5 to not available). Conclusion Treatment with first-line wPac and later-line pazopanib seems to provide survival benefit, especially for patients with advanced angiosarcoma without liver involvement.
참고문헌 (30)
- Young RJ, "Angiosarcoma", Lancet Oncol, 11, pp.983~991 (2010)
- Lahat G, "Angiosarcoma : clinical and molecular insights", Ann Surg, 251, pp.1098~1106 (2010)
- Abraham JA, "Treatment and outcome of 82patients with angiosarcoma", Ann Surg Oncol, 14, pp.1953~1967 (2007)
- Fayette J, "Angiosarcomas, a heterogeneous group of sarcomas with specific behavior depending on primary site : a retrospective study of 161 cases", Ann Oncol, 18, pp.2030~2036 (2007)
- Penel N, "Angiosarcoma : state of the art and perspectives", Crit Rev Oncol Hematol, 80, pp.257~263 (2011)
- Young RJ, "First-line anthracycline-based chemotherapy for angiosarcoma and other soft tissue sarcoma subtypes : pooled analysis of eleven European Organisation for Research and Treatment of Cancer Soft Tissue and Bone Sarcoma Group trials", Eur J Cancer, 50, pp.3178~3186 (2014)
- Penel N, "Phase II trial of weekly paclitaxel for unresectable angiosarcoma : the ANGIOTAX Study", J Clin Oncol, 26, pp.5269~5274 (2008)
- Weidema ME, "Targeting angiosarcomas of the soft tissues : a challenging effort in a heterogeneous and rare disease", Crit Rev Oncol Hematol, 138, pp.120~131 (2019)
- Tokuyama W, "Autocrine and paracrine roles of VEGF", VEGFR-2 and VEGF-C, Hum Pathol, pp.2010, 41[DOI]
- Itakura E, "Detection and characterization of vascular endothelial growth factors and their receptors in a series of angiosarcomas", J Surg Oncol, 97, pp.74~81 (2008)
- Agulnik M, "An open-label, multicenter, phase II study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas", Ann Oncol, 24, pp.257~263 (2013)
- van der Graaf WT, "Pazopanib for metastatic soft-tissue sarcoma(PALETTE) : a randomised, double-blind, placebo-controlled phase 3 trial", Lancet, 379, pp.1879~1886 (2012)
- Fletcher CD, "WHO classification of tumours of soft tissue and bone" (2013), IARC Press
- Eisenhauer EA, "New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1)", Eur J Cancer, 45, pp.228~247 (2009)
- "Common terminology criteria for adverse events, v5.0" (2017)[URL]
- Wang L, "Clinicopathological features and prognostic factors in angiosarcoma : A retrospective analysis of 200 patients from a single Chinese medical institute", Oncol Lett, 14, pp.5370~5378 (2017)
- Penel N, "Metastatic angiosarcomas : doxorubicinbased regimens, weekly paclitaxel and metastasectomy significantly improve the outcome", Ann Oncol, 23, pp.517~523 (2012)
- Ray-Coquard IL, "Paclitaxel given once per week with or without bevacizumab in patients with advanced angiosarcoma : a randomized phase II trial", J Clin Oncol, 33, pp.2797~2802 (2015)
- Byeon S, "A Korean single-center, real-world, retrospective study of firstline weekly paclitaxel in patients with metastatic angiosarcoma", Clin Sarcoma Res, 6, pp.8~ (2016)
- Kollar A, "Pazopanib in advanced vascular sarcomas : an EORTC Soft Tissue and Bone Sarcoma Group(STBSG)retrospective analysis", Acta Oncol, 56, pp.88~92 (2017)
- Zietz C, "MDM-2 oncoprotein overexpression, p53 gene mutation, and VEGF up-regulation in angiosarcomas", Am J Pathol, 153, pp.1425~1433 (1998)
- Behjati S, "Recurrent PTPRB and PLCG1 mutations in angiosarcoma", Nat Genet, 46, pp.376~379 (2014)
- Bocci G, "The pharmacological bases of the antiangiogenic activity of paclitaxel", Angiogenesis, 16, pp.481~492 (2013)
- Schutz FA, "Pazopanib : Clinical development of a potent anti-angiogenic drug", Crit Rev Oncol Hematol, 77, pp.163~171 (2011)
- Wagner MJ, "Endothelial cell malignancies : new insights from the laboratory and clinic", NPJ Precis Oncol, 1, pp.11~ (2017)
- Lee SW, "Hepatic angiosarcoma manifested as recurrent hemoperitoneum", World J Gastroenterol, 14, pp.2935~2938 (2008)
- Bhati CS, "Acute liver failure due to primary angiosarcoma : a case report and review of literature", World J Surg Oncol, 6, pp.104~ (2008)
- Chang YP, "The impact of de novo liver metastasis on clinical outcome in patients with advanced non-small-cell lung cancer", PLoS One, 12, pp.e0178676~ (2017)
- Tumeh PC, "Liver metastasis and treatment outcome with anti-PD-1 monoclonal antibody in patients with melanoma and NSCLC", Cancer Immunol Res, 5, pp.417~424 (2017)
- Frentzas S, "Vessel co-option mediates resistance to anti-angiogenic therapy in liver metastases", Nat Med, 22, pp.1294~1302 (2016)