A 67-year-old female developed metastatic angiosarcoma involving the
scalp, left neck, and pulmonary nodules. Disease progression occurred
while she received two cycles of doxorubicin/ifosfamide (Ifex)/mesna
(Mesnex), complicated by sepsis and pneumonia. Radiation was used to
palliate tumor bulk in the neck (4,000 cGy in 16 fractions) with a
minor response (< 10%) lasting 2 months. Upon disease progression
in all three sites, oral thalidomide (Thalomid) was begun at 150 mg
three times daily.
During a 6-week period, the neck mass had an 84% shrinkage (from 7.5 ´
5 cm to 3 ´ 2 cm), while the scalp
and pulmonary lesions remained unchanged. Toxicity was limited to
somnolence, responding to dose reduction to 100 mg three times daily.
After 2 months, thalidomide was stopped because of pulmonary
progression with hemothorax and bronchopleural fistula. Progression
also occurred in the scalp, but the size of the neck lesion remained
unchanged up until the patients demise 3 months later from
CONCLUSION: Thalidomide may have a synergistic role for
combined-modality therapy of angiosarcoma. Integration of thalidomide
into a clinical trial of chemoradiotherapy would be feasible,
straightforward, and merits evaluation.