apatinib and Hemangiosarcoma

An extremely rare condition, radiation-induced angiosarcoma is characterized by a poor prognosis, high recurrence rate and lack of effective treatment. Herein, we present a case report of a 48-year-old female patient with radiation-induced abdominal wall angiosarcoma who showed a dramatic response to low-dose apatinib.. The patient, who was diagnosed with cervical squamous cell carcinoma 20 years ago, had received radiotherapy and chemotherapy after operation. Angiosarcomas of the abdominal wall appeared 9 years later. After repeated surgical operations and intravenous chemotherapy for the angiosarcomas, the patient developed tumor recurrence and pulmonary metastasis. The abdominal wall tumors showed repeated rupture and bleeding, with poor wound healing. On evaluation, laboratory findings detected the negative serum tumor markers CEA, CA 125, CA 15-3 and CA 19-9. Imaging showed multiple subcutaneous nodules and masses in the abdominal wall, accompanied by suspected small subpleural nodule at the lower lobe of the right lung. Immunohistochemistry of previous surgical pathology indicated that CD31, ERG and Vim were positive. The result of whole exome sequencing suggested the mutations of BRAF and HRAS, and the amplification of MYC. Based on the above results, the patient was clinically diagnosed with radiation-induced angiosarcoma of the abdominal wall with pulmonary metastasis. The patient was treated with low-dose apatinib and rejected reoperation or chemotherapy.. At the 6-month follow-up visit, the abdominal wall lesions that had previously ruptured stopped bleeding and showed significant shrinkage. Imaging showed that most of the abdominal wall lesions had partially regressed, and some of the lesions on the abdominal wall and the suspected lesion of subpleural nodule at the lower lobe of the right lung had disappeared.. We described this case and reviewed the literature on radiation-related angiosarcoma. Importantly, this case suggests that apatinib may be an effective and sensitive treatment for radiation-induced angiosarcoma even at the lowest dosage, without aggravating the bleeding of lesions.

Topics: Abdominal Neoplasms; Abdominal Wall; Female; Gene Amplification; Hemangiosarcoma; Humans; Lung Neoplasms; Middle Aged; Mutation; Neoplasms, Radiation-Induced; Protein Kinase Inhibitors; Proto-Oncogene Proteins B-raf; Proto-Oncogene Proteins c-myc; Proto-Oncogene Proteins p21(ras); Pyridines; Treatment Outcome

Angiosarcomas are rare but aggressive tumors with poor prognosis. The treatment of angiosarcomas with vascular endothelial growth factor receptor inhibitors is still in the stage of clinical exploration. Herein we reported a patient of skin angiosarcoma with multiple organ metastasis. She was resistance to multiline chemotherapy and pazopanib but achieved remarkable shrinkage of the lesion after apatinib treatment combined with chemotherapy or alone. The progression-free survival of the primary lesion with KRAS V14I and RBM10 E119D mutations (10 months) was shorter than that of the brain without the mutation ( ≥ 12 months). Although it is not clear whether the KRAS V14I and RBM10 E119D mutations are the main factors that impact the effect of apatinib treatment or not, the results of this study will provide valuable clues for relevant follow-up basic and clinical studies.

Topics: Adult; Antineoplastic Combined Chemotherapy Protocols; Brain Neoplasms; Cyclophosphamide; Doxorubicin; Female; Hemangiosarcoma; Humans; Liver Neoplasms; Lung Neoplasms; Prognosis; Pyridines; Vincristine

Metastatic or relapsed angiosarcoma has a poor prognosis and the efficacy of conventional chemotherapy is often limited. Apatinib, a novel tyrosine kinase inhibitor (TKI) targeting vascular endothelial growth factor receptor-2 (VEGFR2), has been approved for the treatment of advanced gastric cancer.. Herein, we report a patient with advanced angiosarcoma, who received apatinib at a daily dose of 250 to 725 mg, resulting in a partial response for three months, which may be related to Kinase Insert Domain Receptor (KDR) gene amplification.. Our experience reported here indicated that apatinib may be a useful therapeutic option for treatment of patients with advanced angiosarcoma.

Topics: Aged; Antineoplastic Agents; Gene Amplification; Head and Neck Neoplasms; Hemangiosarcoma; Humans; Male; Neoplasm Metastasis; Neoplasm Recurrence, Local; Proto-Oncogene Proteins c-kit; Pyridines; Scalp; Skin Neoplasms; Vascular Endothelial Growth Factor Receptor-2