Outcomes of advanced angiosarcoma and hemangioendothelioma on propranolol based regimens from sarcoma medical oncology clinic in North India.

Abstract

e22539 Background: Angiosarcoma is an extremely rare subtype of soft tissue sarcoma with a dismal prognosis. The response rate with current standard treatment is low and new approaches are needed. Propranolol is a well-known, generic ß-blocker that has recently been approved for the treatment of a benign vascular tumor, hemangioma, with high response rates. Several preclinical studies and case reports suggest that propranolol could also be repurposed to treat malignant vascular tumors like angiosarcoma. Methods: All patients with advanced or unresectable angiosarcoma and hemangioendothelioma that were treated in the Sarcoma medical oncology clinic in North India from January 2016 to August 2018 were included. Patients were treated with 40 mg BID propranolol with or without chemotherapy or targeted agents. Results: Eight patients with angiosarcoma or hemangioendothelioma were treated with propranolol in combination with pazopanib, methotrexate and vinblastine or methotrexate monotherapy. The median follow up period was 15 months, response rates were 14%. Median PFS was not reached, but the 10 months PFS was 60%. Median OS was not reached, but the 10 months OS was 80%. Conclusions: Treatment of angiosarcoma or hemangioendothelioma patients with propranolol in combination with chemotherapy or targeted therapy shows promising results in terms of survival albeit with relatively low response rates .To determine the exact place of propranolol in the treatment of angiosarcoma, more patients need to be treated, the efficacy of propranolol as monotherapy needs to be evaluated and the role of β-adrenergic receptor as a predictive biomarker needs to be clarified further. Additionally, different combination partners should be tested to determine the optimal backbone for the combination therapy with propranolol.