Interesting antitumor activity of lenalidomide in a patient with hepatic epithelioid hemangioendothelioma (HEH).

Abstract

e21511 Background: Epithelioid hemangioendothelioma (HEH) is a rare malignant vascular soft tissue tumor occurring mostly in the liver. The molecular background is still unkonwn and therefore the medical treatment has not been established. Some case reports treated with angiogenesis inhibitors are described. Lenalidomide has anti-proliferative and cytotoxic effects, immunomodulatory properties but also anti-angiogenic activity. In literature there are few case of patient with solid tumors treated with lenalidomide.We report a patient affected by HEH treated with lenalidomide for long time. Methods: In 2010, a 73 year old man arrived our attention with multiple hepatic lesions diagnosed with contrast computed tomography (CT), abdominal magnetic resonance (MR) imaging and contrast enhanced ultrasound (CEUS) of the liver. An ultrasound guided biopsy of an hepatic lesion was made and histopathology exam deposed for the diagnosis of HEH. We decided to treat the patient with lenalidomide 25 mg daily on 1- 21 every 28 days, because a liver transplantation was not inidcated for the age of the patient. The follow up of disease was made by abdominal ultrasound and MR every three/four months. Results: The patient was treated with lenalidomaide for thirty months totally. After six months the imaging showed a stable disease and after ten months MR also demonstrated an intralesional structure modification as colliquative necrosis. In February 2012, after 24 months of continuos therapy, we decide to stop the treatment for fatigue and for other comorbidity of the patient. After five months of suspension, the ultrasound showed a dimensional increase of a target hepatic lesion & so we restarted lenalidomide for other six months. MR imaging demonstrated a stable disease and abdominal ultrasound showed a decrease of the dimension of a target hepatic lesion. The patient is still under treatemnt with a control of disease. Conclusions: HEH is a rare tumors with probably an indolent natural history but this case report suggests an interesting activity of lenalidomide and antiangiogentic drugs in the treatment of this solid tumor. More patients treated with lenalidomide are encouraged and a small phase II study should be proposed.