Paclitaxel-Dependent Prolonged and Persistent Complete Remission Four Years from First Recurrence of Secondary Breast Angiosarcoma

Abstract

Among angiosarcomas, radiation-induced breast sarcomas (RIBS) represent a well-known entity generally characterized by a poor outcome, especially in patients with advanced disease. Despite the unfavorable prognosis, some chemotherapeutic agents have been used to treat these malignancies, occasionally with success. Treatments with demonstrated activity against sarcomas include ifosfamide-based regimens and, more recently, taxane derivatives. We report a case of a patient having a secondary breast angiosarcoma recurring early after surgery, who achieved complete remission following treatment with weekly paclitaxel. After 4 years of maintenance therapy, with an interval between consecutive administrations of no longer than 3 weeks, the patient is still in complete remission. A locoregional recurrence was documented twice during this period, the first as a consequence of a brief treatment interruption and the second because of a treatment delay. Nonetheless, in both instances a new complete remission was rapidly achieved with the resumption of the same treatment, without evidence of any significant adverse effects. We discuss the highly unusual behavior of this malignancy and the possible role of the two different mechanisms of action of paclitaxel-antiangiogenic versus cytotoxic-depending on the schedule of administration, with evidence of "false" drug-resistance.

Chemoradiotherapy with taxane is superior to conventional surgery and radiotherapy in the management of cutaneous angiosarcoma: a multicentre, retrospective study

“…The former only administered docetaxel during the period of radiotherapy; the latter continued chemotherapy until the patient experienced PD . Similarly, Gambini et al . reported a patient with angiosarcoma who had maintenance chemotherapy for 4 years and was alive without disease, and Rhomberg et al .…”

Long-Term Outcomes in Patients with Radiation-Associated Angiosarcomas of the Breast Following Surgery and Radiotherapy for Breast Cancer

“…[37] Other groups have described promising responses to paclitaxel or gemcitabine-taxane (including complete remissions) for resectable primary or recurrent RAAS breast disease. [40-43] These findings highlight the need for well-designed trials to inform the true utility of chemotherapy in this disease.…”

“…[45] Chemotherapy and radiotherapy may have roles to play in cases of unsuccessful surgical clearance; their beneficial effects remain to be defined. [24, 25, 37, 39, 41, 43, 46, 47] Accordingly, well-designed multicenter clinical trials are now urgently needed to advance RAAS care.…”

Radiation-Associated Angiosarcoma After Breast Cancer: High Recurrence Rate and Poor Survival Despite Surgical Treatment with R0 Resection

“…A small single-center study ( n  = 14) that looked at hyperfractionated and accelerated radiotherapy (HART), with or without surgical resection, found a 64 % 5-year progression-free survival 9. Other studies reported a good response to (neo-) adjuvant treatment with paclitaxel in some patients 12 , 21 , 22. Interpretation of these results is hampered by the limited number of cases and the heterogeneity of the study populations.…”