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. 2024 Dec:78:103825.
doi: 10.1016/j.breast.2024.103825. Epub 2024 Oct 21.

Neoadjuvant chemotherapy for radiation associated angiosarcoma (RAAS) of the breast: A retrospective single center study

Stijn J C van der Burg  1 , Sophie J M Reijers  1 , Anke Kuijpers  1 , Lotte Heimans  2 , Astrid N Scholten  3 , Rick L M Haas  3 , Hester van Boven  4 , Willemijn M Kolff  5 , Marie-Jeanne T F D Vrancken Peeters  1 , Martijn Kerst  2 , Beatrijs A Seinstra  6 , Neeltje Steeghs  2 , Winette T A van der Graaf  2 , Yvonne M Schrage  1 , Winan J van Houdt  7
Affiliations

Neoadjuvant chemotherapy for radiation associated angiosarcoma (RAAS) of the breast: A retrospective single center study

Stijn J C van der Burg et al. Breast. 2024 Dec.

Abstract

Background: Radiation associated angiosarcoma (RAAS) of the breast is a rare malignancy with poor survival. Optimal treatment strategies remain uncertain due to a lack of data, and vary between surgery alone and a combination of surgery with (neo)adjuvant chemotherapy (NACT) and/or re-irradiation. The aim of this study was to evaluate the potential benefit of taxane based NACT.

Methods: In this retrospective single center study, all patients with RAAS of the breast treated between 1994 and 2024 are included. Since 2018, NACT is considered a treatment option for this patient population in our institute. The difference in oncological outcomes of patients with and without NACT were compared.

Results: Thirty-five women were included. Thirteen (37 %) received NACT of which five (39 %) also had neoadjuvant re-irradiation with hyperthermia. Eleven patients (85 %) received paclitaxel, the other two (15 %) had doxorubicine/docetaxel. Complete pathological response was found in 69 % (n = 9). Median follow up was 41 months (range 24-56) for patients with NACT and 44 (range 20-108) for patients without NACT. In the NACT group, only one patient developed a recurrence after 6.5 years. Patients with NACT had improved oncological outcomes compared to patients without NACT in terms of 3-year local recurrence free survival (100% vs. 63.9 %, p = 0.14), distant metastasis free survival (100 % vs. 47.5 %, p = 0.005), and overall survival (100% vs. 56.1 %, p = 0.016).

Conclusion: In this study, neoadjuvant taxanes for RAAS of the breast leads to improved distant metastasis free survival and overal survival in patients treated with NACT compared to no NACT.

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Conflict of interest statement

Declaration of competing interest N. Steeghs provided consultation or attended advisory boards for Boehringer Ingelheim, Ellipses Pharma, GlaxoSmithKline, Incyte, Luszana. N Steeghs received research grants from Abbvie, Actuate Therapeutics, Amgen, Array, Ascendis Pharma, AstraZeneca, Bayer, Blueprint Medicines, Boehringer Ingelheim, Bristol-Myers Squibb, Cantargia, CellCentric, Cogent Biosciences, Cresecendo Biologics, Cytovation, Deciphera, Dragonfly, Eli Lilly, Exelixis, Genentech, GlaxoSmithKline, IDRx, Immunocore, Incyte, InteRNA, Janssen, Kinnate Biopharma, Kling Biotherapeutics, Lixte, Luszana, Merck, Merck Sharp & DohmeMerck Sharp & Dohme, Merus, Molecular Partners, Navire Pharma, Novartis, Numab Therapeutics, Pfizer, Relay Pharmaceuticals, Revolution Medicin, Roche, Sanofi, Seattle Genetics, Taiho, Takeda. All outside the submitted work, all payment to the Netherlands Cancer Institute. W. van der Graaf: Advisory boards SpringworkTx, Agenus and PTC Therapeutics (all to the institute) and research grants from Eli Lilly (to the Institute). W. van Houdt: advisory boards of Amgen, Boehringer Ingelheim, Sanofi, Novartis, Sirius Pintuition, Belpharma. All payment to the Netherlands Cancer Institute.

Figures

Fig. 1
Fig. 1
(A) Different outcomes of clinical, radiological (MRI), and metabolic response evaluation after neoadjuvant chemotherapy (NACT). Partial response is defined as every state between complete response and stable disease. Stable disease is defined as no change before and after NACT. (B) A waterfall plot demonstrating the response per patient in terms of decrease in vital cells. (single column fitting image, in color).
Fig. 2
Fig. 2
[1] A radiation associated angiosarcoma (RAAS) of the breast before (A) and after (B) four cycles of paclitaxel [2]. A fludeoxyglucose-18 positron emission tomography/computed tomography and magnetic resonance imaging of a patient with RAAS of the breast before (A,C) and after (B,D) six cycles of paclitaxel. (Images used with approval of patients) (single column fitting image, in color).
Fig. 3
Fig. 3
Cumulative incidence curves for local recurrence (left) and distant metastases (right) NACT with no NACT (double column fitting image, in color).
Fig. 4
Fig. 4
Kaplan-Meier curve with overall survival, since start of first treatment, comparing NACT with no NACT. (single column fitting image, in color).
See this image and copyright information in PMC

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