Chemotherapy improves survival in advanced angiosarcoma, uptake relatively low
Chemotherapy is associated with better overall survival (OS) in patients with advanced angiosarcoma, though only a select number receive this treatment, according to findings from the first collaborative study by the Asian Sarcoma Consortium (ASC).
Results of a multivariate analysis showed that patients with a higher ECOG status had an elevated risk of poor outcomes (hazard ratio [HR], 2.11, 95 percent confidence interval [CI], 1.24–3.62; p=0.006 for ECOG 1 and HR, 2.91, 95 percent CI, 1.58–5.36; p=0.001 for ECOG ≥2) compared with those with ECOG 0. [ESMO Asia 2016, abstract 501O_PR]
Compared with patients who received more than one line of chemotherapy, those who did not had poorer OS (HR, 1.62, 95 percent CI, 1.15–2.30; p=0.006).
“After adjusting for ECOG performance status, chemotherapy was associated with improved [OS]. But only half of our patients actually received chemotherapy,” said study lead author Adjunct Associate Professor Richard Quek from the National Cancer Centre Singapore, who presented the findings at the European Society for Medical Oncology (ESMO) Asia 2016, held in Singapore. “It would be important to understand the reasons behind this low treatment rate,” said Quek.
In patients with locally advanced/metastatic/unresectable angiosarcoma (n=191), 32 percent received chemotherapy as first-line treatment regardless of type of angiosarcoma. However, those with visceral angiosarcoma were almost twice as likely to undergo surgery as primary treatment compared with those with cutaneous angiosarcoma (42 percent vs 22 percent; p<0.001).
Of those who underwent chemotherapy, 59 percent of patients with visceral angiosarcoma received more than one line of chemotherapy compared with 52 percent of those with cutaneous angiosarcoma (p=0.02).
Between 1990 and 2016, 423 patients (median age 67 years, 58 percent male) were enrolled in this multicentre (eight sarcoma academic centres in six Asian countries), retrospective, observational study and were followed up over a median 12.4 months.
Fifty-nine and 41 percent of subjects had cutaneous and visceral angiosarcoma, respectively. In individuals with cutaneous angiosarcoma, the scalp or head and neck were the most common primary sites (84 percent, n=210), while the liver was the most common primary site in individuals with visceral angiosarcoma (22 percent, n=38).
Patients with cutaneous angiosarcoma were more likely to be male (67 percent), older (aged >65 years, 72 percent), and have localized disease (62 percent), while patients with visceral angiosarcoma were more likely to be female (56 percent), younger (aged ≤65 years, 75 percent), and have metastatic disease (46 percent).
According to Quek, the overall prognosis of angiosarcoma is poor. “This study gives us new and significant insights into the real world treatment and outcomes of angiosarcoma patients in Asia,” he concluded.