Successful Treatment of Cardiac Angiosarcoma Associated with Disseminated Intravascular Coagulation with Nab-Paclitaxel: A Case Report and Review of the Literature

Abstract

Angiosarcoma of the heart is an uncommon soft tissue sarcoma. A few cases of disseminated intravascular coagulation (DIC) associated with angiosarcoma occurring in various organs, but not the heart, have been reported. Although taxane is commonly used in the treatment of metastatic angiosarcoma, data on the efficacy of nab-paclitaxel for angiosarcoma are limited. Here, we report probably the first case of a patient with primary cardiac angiosarcoma with coexisting DIC who was successfully treated with nab-paclitaxel. A 62-year-old female with chief complaints of nausea and shortness of breath was diagnosed as having cardiac angiosarcoma with liver metastases. Four months after the resection of her primary tumor, the hepatic metastatic lesions progressed rapidly accompanied by new metastatic lesions in the right iliac bone and signs of DIC. She received nab-paclitaxel as first-line chemotherapy. A response of stable disease was achieved after 2 treatment cycles and DIC was successfully controlled for at least 4 months. This report suggests potential utility of nab-paclitaxel for angiosarcoma complicated with DIC. We also review the literature for all cases of angiosarcoma with DIC reported so far.

Primary breast angiosarcoma with disseminated intravascular coagulation is successfully treated with self‑subcutaneous unfractionated heparin calcium injection: A case report

“…Only a few case reports mention anticoagulant therapies for DIC associated with angiosarcoma. Honda et al ( 7 ) reported the first case of a patient having primary cardiac angiosarcoma with coexisting DIC who was successfully treated with nab-PTX. This patient's DIC, treated with transfusion of fresh-frozen plasma and recombinant thrombomodulin-α (used for 6 days), improved shortly after the initiation of chemotherapy.…”

The effect of ifosfamide, epirubicin, and recombinant human endostatin therapy on a cardiac angiosarcoma

“…[18] There are 3 cases reported of treating cardiac angiosarcoma with paclitaxel to good effect, from partial response to complete remission of primary tumor and distal metastasis but unfortunately it was not work in our patient. [19–21] Ifosfamide is a broad used chemotherapy drug in angiosarcoma, combining with doxorubicin achieved a well effect was reported and epirubicin, another anthracycline drug, always combined with ifosfamide as chemotherapy regimen for soft-tissue sarcoma. [22] Endostatin is a wide spectrum tumor angiogenesis inhibitor, with slight side-effects.…”

“…[6] Others such as chemotherapy or radiotherapy were effective only in sporadic cases. [19–21] In this case, we aimed to discuss the effect of ifosfamide and epirubicin (IE) plus recombinant human endostatin (rh-endostatin) following palliative surgery.…”

Multifocal Epithelioid Hemangioendothelioma Complicated with Disseminated Intravascular Coagulation

“…Conversely, tumor progression led to worsening of DIC. While treatment of DIC is usually targeted to the underlying cause, challenges arise when there is no available treatment option for the underlying cause [ 11 ].…”