Sylvester Doctors Finding Ways to Identify Best Treatments for a Rare Cancer

New research supports changing how many oncologists approach breast angiosarcoma.

Researchers at Sylvester Comprehensive Cancer Center, part of the University of Miami Health System, have found that neoadjuvant chemotherapy, given before surgery to reduce tumor size, improves survival in patients with rare breast angiosarcomas. The study was published in the journal Cancers.

Jonathan Trent, M.D.

“Angiosarcoma is insidious because we can’t necessarily visualize the extent of disease when we operate,” said surgical oncologist and senior author on the paper, Neha Goel, M.D. “We try to give patients chemotherapy to decrease tumor burden, especially for disease we can’t see with the naked eye. This gives patients the best chance of having negative margins and potentially curative surgery.”

Sarcomas are rare bone and soft tissue cancers that affect only about 13,000 people in the U.S. each year. Breast angiosarcomas, which affect the inner linings of blood vessels, can be caused by previous radiation treatments or arise spontaneously, and are even less common.

“They are a rare subset of a rare subset of a rare subset,” said co-author Jonathan Trent, M.D., Ph.D., director of Sarcoma Oncology at Sylvester.

Because breast angiosarcoma is so rare, treatment protocols have been poorly defined, particularly at small community hospitals, where an oncologist might see only one breast angiosarcoma case during their entire career. Patients outside of sarcoma centers often receive no chemotherapy for primary breast angiosarcoma and rarely receive neoadjuvant therapy before surgical resection.

Seeking Patient Data

In this study, the researchers wanted to understand whether more strategic treatment protocols could improve patient outcomes. Looking at patient data between 2010 and 2020, the team found 22 PAS and RAAS patients who met the inclusion criteria. The study concluded that neoadjuvant chemotherapy could improve outcomes for both breast angiosarcoma types.

Neha Goel, M.D.

The paper also disproves the common wisdom that RAAS patients do poorly, regardless of treatment. The data showed overall survival was 90 months for RAAS patients compared to 81 months for PAS patients.

“We found that if a woman with a radiation-associated angiosarcoma is treated at a multi-disciplinary, experienced sarcoma center, they have just as good of an outcome as women who have a spontaneous breast angiosarcoma,” Dr. Trent said.

The authors stress that breast angiosarcoma patients must be treated individually based on the extent of their disease with all oncology disciplines weighing in.

“One of the main goals of this paper was to show we can do better as a team when providing chemotherapy, surgery and radiation,” Dr. Goel said. “This multidisciplinary approach has been shown to improve outcomes in many cancers, and now we are extending that data to angiosarcoma.”

Having shown the impact of neoadjuvant chemotherapy retrospectively, the authors hope to continue this work.

“One of our goals,” Dr. Goel said, “is to use this knowledge to develop a multi-institutional study and clinical trial to evaluate outcomes in a larger population and move closer to finding a cure for women with breast angiosarcoma.”

Tags: Dr. Jonathan Trent, Neha Goel, Sylvester Comprehensive Cancer Center