27 Dec Epidemiology and Outcomes of Angiosarcoma
MedicalResearch.com Interview with:
Dr. Richard Quek MBBS, MRCP, FAMS
Senior Consultant, Medical Oncology
Parkway Cancer Centre
MedicalResearch.com: What is the background for this study?
Response: Angiosarcoma is an uncommon form of aggressive soft tissue sarcoma (STS). It comprises of 2 distinct subgroups of patients: one originating from the skin – typically scalp, seen predominantly in elderly patients while the second subgroup affects younger patients and tends to originate from visceral organs including the liver and breasts. Angiosarcoma may also develop as a complication of prior radiation treatment. Prognosis in patient is poor, with survival generally less than 1 year in those with advanced or unresectable disease. Optimal treatment remains unclear; most published series on angiosarcoma tends to be small singlecenter studies.
In our previous Asian STAR study evaluating epidemiology, treatment patterns and outcomes in Asian patients diagnosed with STS [J Clin Oncol 33, 2015 (suppl; abstract 10549)], we found that angiosarcoma represented 7% of the cohort, a proportion higher than what we would have expected from published series coming out of the west and hence our interest in this subject.
MedicalResearch.com: What are the main findings?
Response: To understand the real world treatment, prognostic factors and clinical outcomes of angiosarcoma in Asia, we conducted a multi-centre retrospective study involving 8 academic sarcoma centres in 6 Asian countries. A total of 423 patients were enrolled. We found that about 59% of patients had cutaneous angiosarcoma as compared to 41% with visceral angiosarcoma. In patients with localized angiosarcoma, surgery was first line treatment in 61% and negative margins obtained in only approximately 70% of patients whose margin status was known. Median relapse free survival was 12.3 months. Multivariate analysis revealed that age < 65 years and negative surgical margins were independent prognostic factors for relapse-free survival. While in patients with advanced angiosarcoma, only 55% of patients enrolled received systemic chemotherapy. Median overall survival in this cohort was 9.5 months. Multivariate analysis performed showed that ECOG performance status was an independent prognostic factor for overall survival in patients with advanced angiosarcoma. Interestingly, after adjusting for ECOG performance status, use of chemotherapy was associated with improved overall survival.
MedicalResearch.com: What should readers take away from your report?
Response: The data raises several provocative hypotheses.
Firstly, the study highlights the chemo-sensitive nature of angiosarcoma and potential benefits of systemic treatment in this disease subset. Thus, in well selected patients, palliative systemic treatment should be considered. However, the reasons behind the relatively low use of systemic chemotherapy in the real world treatment of these patients is as yet unclear and would be an interesting subject of further investigation.
In the localized setting, our data showed that a negative surgical margin was only achieved in approximately 70% of cases, and negative surgical margins had a direct impact on relapse-free survival. Thus our data calls for a re-examination of our treatment paradigm, arguing for the consideration of pre-operative therapies in bid to improve tumour resectability and clinical outcomes.
MedicalResearch.com: What recommendations do you have for future research as a result of this study?
Response: Prospective studies evaluating the role of pre-operative treatment, be it chemotherapy and/or radiation treatment, would be very important to move this field forward and help us optimize treatment in this subset of patients with localized angiosarcoma.
Additionally, we would be very keen to understand the reasons behind the low usage of systemic treatment in patients with advanced angiosarcoma and act on those information in a systemic fashion to improve clinical outcomes for our patients.
MedicalResearch.com: Is there anything else you would like to add?
Response: To our knowledge, this study by the Asian Sarcoma Consortium (ASC) comprising of 423 patients is one of the largest, if not largest, of its kind in angiosarcoma ever reported. It provides us with a first glimpse of our patients from Asia and serves as a basis for us to review our clinical practice so as to improve outcomes for our patients. Sarcoma being an uncommon disease would clearly benefit from collaborative research such as this in order to move the field forward.
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ESMO Asia 2016 abstract:
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