Secondary Breast Angiosarcoma: Lethal Response to Anti-angiogenic Therapy with Paclitaxel Chemotherapy. A Case Report

Angiosarcoma of the breast is a malignant tumour of vascular endothelial cells. It is a rare and difficult tumour to treat. The authors report a case of cutaneous radiation- associated angiosarcoma treated with paclitaxel chemotherapy. A few days after drug administration, bleeding of skin lesions was observed and the patient died. Angiosarcomas are rare, aggressive tumors with pathological and morphological properties similar to the vascular endothelium that can occur in any region of the body. The incidence of angiosarcomas among malignant breast is 0.02%. Angiosarcomas have been frequently reported to arise in the irradiated breast after breast- conserving therapy but, despite the distinction between primary and secondary angiosarcomas of the breast, the natural history is remarkably comparable, with a median survival period of 14.5-34 months and a 5-year survival rate of approximately 15%. Optimal treatment has not been well defined: surgical procedure is recommended if the disease is localised, while radiotherapy could contribute to local or palliative control. If the disease is extensive, chemotherapy regimens based on paclitaxel have shown activity in few patients with involved sites other than the breast. The exact cytotoxic action of this drug is not fully understood, but it appears to be mediated through two different mechanisms: the mitotic arrest leading to apoptosis in the tumor cells and anti-angiogenic activities targeting endothelial cells currently demonstrated in vitro and in vivo.