Secondary breast angiosarcoma and paclitaxel-dependent prolonged disease control: report of two cases and review of the literature.

Secondary breast angiosarcomas are a well-known entity generally characterized by a poor outcome, especially in patients with advanced disease. Among the drugs with demonstrated activity, taxane derivatives are one of the most effective histology-driven treatments against angiosarcomas. We report two cases of secondary breast angiosarcoma, both characterized by a very peculiar behavior towards paclitaxel. Both patients showed local recurrence of angiosarcoma after primary surgery, and they achieved complete remission following treatment with weekly paclitaxel. When a locoregional recurrence was observed as a result of a brief treatment interruption or a treatment delay, a new complete remission was rapidly achieved with the resumption of the drug, without evidence of any significant adverse effects.

Sunitinib-induced complete response in metastatic renal cancer expressing neuroendocrine markers: a new predictive factor?

BACKGROUND: To date, no predictive factors are recognized and applied in the therapeutic choice for metastatic renal cell carcinoma. Due to significant side-effects and costs, which are relevant issues in this setting, optimization of treatments has become a priority. CASE REPORT: We herein report a case of complete remission of metastatic renal cell carcinoma after 1 year of treatment with sunitinib. Since pancreatic metastases were detected by a 68Ga-DOTA-NOC positron emission tomography, it was decided to perform a histological revision of the specimens, with immunohistochemical staining for neuroendocrine markers on the primary tumor. CONCLUSION: On the basis of the detection of neuroendocrine markers on the primary neoplasm, together with pancreatic metastases positive on a 68Ga-DOTA-NOC positron emission tomography (PET), we hypothesize and discuss about a potential role of specific neuroendocrine markers as predictive indicators of response to sunitinib (and allegedly to other target therapies) in the treatment of this neoplasm.

Uncommon breast malignancies: presentation pattern, prognostic issue and treatment outcome in an Italian single institution experience.

AIMS AND BACKGROUND: Often neglected by large clinical trials, patients with uncommon breast malignancies have been rarely analyzed in large series. PATIENTS AND METHODS: Of 2,052 patients diagnosed with breast cancer and followed in our Institution from January 1985 to December 2009, we retrospectively collected data on those with uncommon histotypes, with the aim of investigating their presentation characteristics and treatment outcome. RESULTS: Rare histotypes were identified in 146 patients (7.1% of our total breast cancer population), being classified as follows: tubular carcinoma in 75 (51.4%), mucinous carcinoma in 36 (24.7%), medullary carcinoma in 25 (17.1%) and papillary carcinoma in 10 patients (6.8%). Whereas age at diagnosis was not significantly different among the diverse diagnostic groups, patients with medullary and papillary subtypes had a higher rate of lymph node involvement, similar to that of invasive ductal carcinoma. Early stage diagnosis was frequent, except for medullary carcinoma. Overall, in comparison with our invasive ductal carcinoma patients, those with rare histotypes showed a significantly lower risk of recurrence, with a hazard ratio of 0.28 (95% CI, 0.12-0.62; P = 0.002). CONCLUSIONS: According to our analysis, patients with uncommon breast malignancies are often diagnosed at an early stage, resulting in a good prognosis with standard treatment.

Paclitaxel-dependent prolonged and persistent complete remission four years from first recurrence of secondary breast angiosarcoma.

Among angiosarcomas, radiation-induced breast sarcomas (RIBS) represent a well-known entity generally characterized by a poor outcome, especially in patients with advanced disease. Despite the unfavorable prognosis, some chemotherapeutic agents have been used to treat these malignancies, occasionally with success. Treatments with demonstrated activity against sarcomas include ifosfamide-based regimens and, more recently, taxane derivatives. We report a case of a patient having a secondary breast angiosarcoma recurring early after surgery, who achieved complete remission following treatment with weekly paclitaxel. After 4 years of maintenance therapy, with an interval between consecutive administrations of no longer than 3 weeks, the patient is still in complete remission. A locoregional recurrence was documented twice during this period, the first as a consequence of a brief treatment interruption and the second because of a treatment delay. Nonetheless, in both instances a new complete remission was rapidly achieved with the resumption of the same treatment, without evidence of any significant adverse effects. We discuss the highly unusual behavior of this malignancy and the possible role of the two different mechanisms of action of paclitaxel-antiangiogenic versus cytotoxic-depending on the schedule of administration, with evidence of "false" drug-resistance.