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Communications to the Editor |

Treatment of a Primary Pulmonary AngiosarcomaTreatment of a Primary Pulmonary Angiosarcoma FREE TO VIEW

Lionel Duck, MD; Jean-François Baurain, MD, PhD; Jean-Pascal Machiels, MD, PhD
Author and Funding Information

Affiliations: Université Catholique de Louvain, Brussels, Belgium,  Kumamoto University Kumamoto, Japan,  Kumamoto Central Hospital, Kumamoto, Japan

Correspondence to: Lionel Duck, MD Unité d’Oncologie Médicale, Cliniques Universitaires St-Luc, Av Hippocrate 10, 1200 Brussels, Belgium; e-mail: lionel.duck@onco.ucl.ac.be



Chest. 2004;126(1):317-318. doi:10.1378/chest.126.1.317
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To the Editor:

We read with interest the article by Kojima and colleagues (December 2003)1 concerning the treatment of a primary pulmonary angiosarcoma (AS). They used simultaneously IV recombinant interleukin-2 (rIL-2) and external radiotherapy (RX) for treating this nonmetastatic inoperable AS. Kojima and associates wrote in their article that “this combination therapy may be a promising strategy to prolong the survival of patients with primary pulmonary angiosarcoma.” Although they obtained a surprising and sustained good response (more than a year) in this case, we would like to make a few comments.

rIL-2 has often been tried to treat different types of cancers. Tumor responses were observed mainly in patients with melanoma and renal cell carcinoma.2Kojima et al mentioned the study of Masuzawa et al3and wrote that the “systemic administration of high doses of rIL-2 was also highly effective and induced the regression of pulmonary metastasis,” but these conclusions are drawn from mice only. In human AS, rIL-2 therapy was almost always used with RX or chemotherapy, and, therefore, the potential efficacy of rIL-2 by itself cannot be assessed in AS, since it is also known to be a radiosensitive tumor. Of notice, in the retrospective study (30 patients) performed by Sasaki et al,4and referenced by Kojima et al, the four long-term survivors (ie, > 3 years) were patients with nonmetastatic AS who had been treated with rIL-2 but also with curative RX. Finally, several chemotherapeutic drugs were tested in patients with AS. A few of them showed promising activity, except for paclitaxel in skin (ie, face and scalp) ASs.5 This drug gave interesting results (eight partial and complete responses among nine patients) when used alone without RX, unlike the case with rIL-2. In our opinion, rIL-2 may be valuable in the treatment of patients with AS, but its efficacy should first be evaluated as a single agent before using it in association with RX. Moreover, one should be cautious with rIL-2 because of its potential toxicity, especially at high dosages.

Kojima, K, Okamoto, I, Ushijima, S, et al (2003) Successful treatment of primary pulmonary angiosarcoma.Chest124,2397-2400. [CrossRef] [PubMed]
 
Nathan, PD, Eisen, TG The biological treatment of renal-cell carcinoma and melanoma.Lancet Oncol2002;3,89-96. [CrossRef] [PubMed]
 
Masuzawa, M, Mochida, N, Amano, T, et al Evaluation of a recombinant interleukin-2 immunotherapy for human hemangiosarcoma in a SCID mice model (WB-SCID).J Dermatol Sci2001;27,88-94. [CrossRef] [PubMed]
 
Sasaki, R, Soejima, T, Kishi, K, et al Angiosarcoma treated with radiotherapy: impact of tumor type and size on outcome.Int J Radiat Oncol Biol Phys2002;52,1032-1040. [CrossRef] [PubMed]
 
Fata, F, O’Reilly, E, Ilson, D, et al Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face.Cancer1999;86,2034-2037. [CrossRef] [PubMed]
 

Treatment of a Primary Pulmonary Angiosarcoma

To the Editor:

We thank Duck and colleagues for their comments on our article (December 2003),1 and we appreciate the opportunity to respond. They describe in their letter that recombinant interleukin (rIL)-2 may be valuable in the treatment of primary pulmonary angiosarcoma (AS), but its efficacy should first be evaluated as a single agent before using it in association with radiotherapy. The patient in our study, who was given high doses of rIL-2 combined with radiotherapy, had no unmanageable side effects and has remained progression-free for almost 2 years after diagnosis. The excellent clinical outcome is outstanding among those previously reported in primary pulmonary AS patients, who died within months of the initial presentation. Since biological therapies, including those utilizing high-dose IL-2, differ from chemotherapeutic approaches in terms of mechanism of action, toxicity, and response profile, one should interpret the clinical activity with due caution.

We have not been able to conclude from the presented case that rIL-2 itself possesses substantial antitumor activity against primary pulmonary AS, even though evidence has been growing in a fraction of patients with metastatic melanoma and renal cell carcinoma.2 On the basis of the sensitivity of AS to radiotherapy, it is possible that concomitant radiotherapy may enhance immunogenicity by causing cellular damage and activating IL-2-stimulated cellular effectors. The consequent synergistic effects might be required to achieve the remarkable and durable response that was observed in our patient. Further investigation to explore the molecular and cellular mode of action of the combination of radiotherapy and immunotherapy will be awaited, as well as the more clinically successful experiences of this challenging disease.

References
Kojima, K, Okamoto, I, Ushijima, S, et al Successful treatment of primary pulmonary angiosarcoma.Chest2003;124,2397-2400. [CrossRef] [PubMed]
 
Nathan, PD, Eisen, TG The biological treatment of renal-cell carcinoma and melanoma.Lancet Oncol2002;3,89-96. [CrossRef] [PubMed]
 

Figures

Tables

References

Kojima, K, Okamoto, I, Ushijima, S, et al (2003) Successful treatment of primary pulmonary angiosarcoma.Chest124,2397-2400. [CrossRef] [PubMed]
 
Nathan, PD, Eisen, TG The biological treatment of renal-cell carcinoma and melanoma.Lancet Oncol2002;3,89-96. [CrossRef] [PubMed]
 
Masuzawa, M, Mochida, N, Amano, T, et al Evaluation of a recombinant interleukin-2 immunotherapy for human hemangiosarcoma in a SCID mice model (WB-SCID).J Dermatol Sci2001;27,88-94. [CrossRef] [PubMed]
 
Sasaki, R, Soejima, T, Kishi, K, et al Angiosarcoma treated with radiotherapy: impact of tumor type and size on outcome.Int J Radiat Oncol Biol Phys2002;52,1032-1040. [CrossRef] [PubMed]
 
Fata, F, O’Reilly, E, Ilson, D, et al Paclitaxel in the treatment of patients with angiosarcoma of the scalp or face.Cancer1999;86,2034-2037. [CrossRef] [PubMed]
 
Kojima, K, Okamoto, I, Ushijima, S, et al Successful treatment of primary pulmonary angiosarcoma.Chest2003;124,2397-2400. [CrossRef] [PubMed]
 
Nathan, PD, Eisen, TG The biological treatment of renal-cell carcinoma and melanoma.Lancet Oncol2002;3,89-96. [CrossRef] [PubMed]
 
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