Zusammenfassung
Hintergrund
Das kutane Angiosarkom ist ein äußerst seltener Tumor des älteren Menschen. Die weite Resektion ist eine potenziell kurative Therapieoption. Bedingt durch die häufige Lokalisation am Kopf, ein oftmals diffuses und multifokales Wachstum und Risikofaktoren dieser Altersgruppe ist selbst eine palliative Resektion in Kombination mit Strahlen- und Chemotherapie häufig nicht sinnvoll. Primär inoperable kutane Angiosarkome sollten einer Radiochemotherapie zugeführt werden. Ein besseres Therapieansprechen ist für die kombinierte Radiochemotherapie verglichen mit alleiniger Operation und Radiatio beschrieben. Taxan- und Doxorubicin-basierte Chemotherapieprotokolle sind etabliert.
Methode
Wir stellen 6 Patienten mit primär inoperablem kutanem Angiosarkom vor, die eine Radiatio und eine Chemotherapie mit liposomal verkapseltem, pegyliertem Doxorubicin in einer Dosis von 25 mg/m2 alle 2 Wochen erhielten.
Ergebnisse
Es ergab sich unter dieser Therapie ein medianes progressionsfreies Überleben (PFS) von 8 Monaten (5 bis 14 Monate). Das mediane Gesamtüberleben („overall survival“ [OS]) lag bei 13 Monaten (13 bis 34 Monate). Es zeigte sich bei 4 Patienten unter Therapie initial ein partielles Ansprechen („partial response“ [PR]). Bei 2 Patienten musste die Therapie aufgrund von schweren Nebenwirkungen nach 1,5 Monaten (4 Therapiezyklen) bzw. 7 Monaten (15 Therapiezyklen) abgebrochen werden.
Diskussion
Anhand der vorliegenden Daten kann die beschriebene kombinierte Therapie von Radiatio und liposomal verkapseltem, pegyliertem Doxorubicin als eine wichtige palliative Behandlungsmöglichkeit des primär inoperablen kutanen Angiosarkoms bewertet werden. Aufgrund der limitierten Wirksamkeit der Radiochemotherapie sind neue Therapiekonzepte dringend erforderlich.
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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P. Terheyden erhielt Vortragshonorare von BMS, Novartis, Pierre-Fabre, CureVac und Roche sowie Beraterhonorare von BMS, Merck, Novartis, Pierre-Fabre, Merck Serono, Sanofi und Roche. Reisekosten und Kongressgebühren wurden für ihn erstattet von BMS, Pierre-Fabre und Roche. Ihm wurde Studienunterstützung (Drittmittel) zuteil von den Firmen BMS, Roche und Novartis. N. Bönisch und E.A. Langan geben an, dass kein Interessenkonflikt besteht.
Alle beschriebenen Untersuchungen am Menschen oder an menschlichem Gewebe wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.
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Bönisch, N., Langan, E.A. & Terheyden, P. Kutanes Angiosarkom. Hautarzt 70, 700–706 (2019). https://doi.org/10.1007/s00105-019-4462-0
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DOI: https://doi.org/10.1007/s00105-019-4462-0