Difference between revisions of "Vascular sarcoma"
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=Kaposi sarcoma, all lines of therapy= | =Kaposi sarcoma, all lines of therapy= | ||
− | ==ABV {{#subobject:4531b5|Regimen=1}}== | + | ==ABV (Vinblastine) {{#subobject:3b312f|Regimen=1}}== |
+ | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
+ | |- | ||
+ | |[[#top|back to top]] | ||
+ | |} | ||
+ | ABV: '''<u>A</u>'''driamycin (Doxorubicin), '''<u>B</u>'''leomycin, '''<u>V</u>'''inblastine | ||
+ | ===Regimen {{#subobject:097d6d|Variant=1}}=== | ||
+ | {| class="wikitable" style="width: 100%; text-align:center;" | ||
+ | !style="width: 50%"|Study | ||
+ | !style="width: 50%"|[[Levels_of_Evidence#Evidence|Evidence]] | ||
+ | |- | ||
+ | |[http://ascopubs.org/doi/abs/10.1200/JCO.1984.2.10.1115 Laubenstein et al. 1984] | ||
+ | | style="background-color:#91cf61" |Non-randomized | ||
+ | |- | ||
+ | |} | ||
+ | ====Chemotherapy==== | ||
+ | *[[Doxorubicin (Adriamycin)]] | ||
+ | *[[Bleomycin (Blenoxane)]] | ||
+ | *[[Vinblastine (Velban)]] | ||
+ | ===References=== | ||
+ | # Laubenstein LJ, Krigel RL, Odajnyk CM, Hymes KB, Friedman-Kien A, Wernz JC, Muggia FM. Treatment of epidemic Kaposi's sarcoma with etoposide or a combination of doxorubicin, bleomycin, and vinblastine. J Clin Oncol. 1984 Oct;2(10):1115-20. [http://ascopubs.org/doi/abs/10.1200/JCO.1984.2.10.1115 link to original article] [https://www.ncbi.nlm.nih.gov/pubmed/6208343 PubMed] | ||
+ | |||
+ | ==ABV (Vincristine) {{#subobject:4531b5|Regimen=1}}== | ||
{| class="wikitable" style="float:right; margin-left: 5px;" | {| class="wikitable" style="float:right; margin-left: 5px;" | ||
|- | |- | ||
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|} | |} | ||
ABV: '''<u>A</u>'''driamycin (Doxorubicin), '''<u>B</u>'''leomycin, '''<u>V</u>'''incristine | ABV: '''<u>A</u>'''driamycin (Doxorubicin), '''<u>B</u>'''leomycin, '''<u>V</u>'''incristine | ||
− | + | ===Variant #1, 10/15/1 {{#subobject:b47ecf|Variant=1}}=== | |
− | ===Variant #1 {{#subobject: | ||
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
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!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
− | |[http://jco.ascopubs.org/content/ | + | |[http://jco.ascopubs.org/content/14/8/2353.long Gill et al. 1996] |
|style="background-color:#1a9851"|Phase III (C) | |style="background-color:#1a9851"|Phase III (C) | ||
− | |[[# | + | |[[#Daunorubicin_liposomal_monotherapy|Liposomal daunorubicin]] |
− | |style="background-color:# | + | |style="background-color:#ffffbf"|Seems not superior |
|- | |- | ||
|} | |} | ||
+ | |||
+ | ''Gill et al. 1996 described doses but did not clearly say in the paper when these drugs were given, but this schedule is assumed based on the Northfelt et al. 1998 ABV regimen. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.'' | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Doxorubicin (Adriamycin)]] | + | *[[Doxorubicin (Adriamycin)]] 10 mg/m<sup>2</sup> IV once on day 1 |
− | *[[Bleomycin (Blenoxane)]] | + | *[[Bleomycin (Blenoxane)]] 15 units IV once on day 1 |
*[[Vincristine (Oncovin)]] 1 mg IV once on day 1 | *[[Vincristine (Oncovin)]] 1 mg IV once on day 1 | ||
====Supportive medications==== | ====Supportive medications==== | ||
− | *" | + | *"No routine premedication was established by the protocol, but it could be provided at the discretion of the investigator" |
− | '''14-day cycle for | + | '''14-day cycle for minimum of 2 cycles; given until complete remission, unacceptable toxicity, disease progression, patient refusal, or death''' |
− | ===Variant #2 {{#subobject: | + | ===Variant #2, 20/10/1 {{#subobject:d923d9|Variant=1}}=== |
{| class="wikitable" style="width: 100%; text-align:center;" | {| class="wikitable" style="width: 100%; text-align:center;" | ||
!style="width: 25%"|Study | !style="width: 25%"|Study | ||
Line 117: | Line 140: | ||
!style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | !style="width: 25%"|[[Levels_of_Evidence#Efficacy|Efficacy]] | ||
|- | |- | ||
− | |[http://jco.ascopubs.org/content/ | + | |[http://jco.ascopubs.org/content/16/7/2445.long Northfelt et al. 1998] |
|style="background-color:#1a9851"|Phase III (C) | |style="background-color:#1a9851"|Phase III (C) | ||
− | |[[# | + | |[[#Doxorubicin_pegylated_liposomal_monotherapy|Pegylated liposomal doxorubicin]] |
− | |style="background-color:# | + | |style="background-color:#d73027"|Inferior ORR |
|- | |- | ||
|} | |} | ||
− | + | ''Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.'' | |
− | '' | ||
====Chemotherapy==== | ====Chemotherapy==== | ||
− | *[[Doxorubicin (Adriamycin)]] | + | *[[Doxorubicin (Adriamycin)]] 20 mg/m<sup>2</sup> IV once on day 1 |
− | *[[Bleomycin (Blenoxane)]] | + | *[[Bleomycin (Blenoxane)]] 10 mg/m<sup>2</sup> IV once on day 1 |
*[[Vincristine (Oncovin)]] 1 mg IV once on day 1 | *[[Vincristine (Oncovin)]] 1 mg IV once on day 1 | ||
====Supportive medications==== | ====Supportive medications==== | ||
− | *" | + | *"Colony-stimulating factors (CSFs) were prescribed at the discretion of the investigators." |
− | '''14-day cycle for | + | '''14-day cycle for up to 6 cycles''' |
===References=== | ===References=== |
Revision as of 01:46, 9 December 2018
Section editor | |
---|---|
James L. Chen, MD, MS Columbus, OH |
0 regimens on this page
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Guidelines
ESMO
- Soft tissue and visceral sarcomas: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. (2014) PubMed
NCCN
Angiosarcoma, all lines of therapy
Bevacizumab monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Agulnik et al. 2013 | Phase II |
Chemotherapy
- Bevacizumab (Avastin) 15 mg/kg IV once on day 1
21-day cycles, given until progression of disease, intolerance, unacceptable toxicity, patient refusal, or physician discretion
References
- Agulnik M, Yarber JL, Okuno SH, von Mehren M, Jovanovic BD, Brockstein BE, Evens AM, Benjamin RS. An open-label, multicenter, phase II study of bevacizumab for the treatment of angiosarcoma and epithelioid hemangioendotheliomas. Ann Oncol. 2013 Jan;24(1):257-63. link to original article contains verified protocol PubMed
Paclitaxel monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Penel et al. 2008 (ANGIOTAX) | Phase II |
Chemotherapy
- Paclitaxel (Taxol) 80 mg/m2 IV over 60 minutes once per day on days 1, 8, 15
Supportive medications
- Dexamethasone (Decadron) 8 mg IV once prior to paclitaxel
- Cimetidine (Tagamet) 200 mg IV once prior to paclitaxel
- Dexchlorpheniramine (Polaramine) (note: was spelled as dexchloropheramine in the Penel et al. 2008) 5 mg IV once prior to paclitaxel
- "Standard antiemetics (mainly Metoclopramide (Reglan)) were prescribed as clinically indicated by the treating physician"
28-day cycle for 6 cycles
References
- Penel N, Bui BN, Bay JO, Cupissol D, Ray-Coquard I, Piperno-Neumann S, Kerbrat P, Fournier C, Taieb S, Jimenez M, Isambert N, Peyrade F, Chevreau C, Bompas E, Brain EG, Blay JY. Phase II trial of weekly paclitaxel for unresectable angiosarcoma: the ANGIOTAX Study. J Clin Oncol. 2008 Nov 10;26(32):5269-74. Epub 2008 Sep 22. link to original article contains verified protocol PubMed
Hemangioendothelioma, all lines of therapy
Hemangiopericytoma (solitary fibrous tumor), all lines of therapy
Kaposi sarcoma, all lines of therapy
ABV (Vinblastine)
back to top |
ABV: Adriamycin (Doxorubicin), Bleomycin, Vinblastine
Regimen
Study | Evidence |
---|---|
Laubenstein et al. 1984 | Non-randomized |
Chemotherapy
References
- Laubenstein LJ, Krigel RL, Odajnyk CM, Hymes KB, Friedman-Kien A, Wernz JC, Muggia FM. Treatment of epidemic Kaposi's sarcoma with etoposide or a combination of doxorubicin, bleomycin, and vinblastine. J Clin Oncol. 1984 Oct;2(10):1115-20. link to original article PubMed
ABV (Vincristine)
back to top |
ABV: Adriamycin (Doxorubicin), Bleomycin, Vincristine
Variant #1, 10/15/1
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Gill et al. 1996 | Phase III (C) | Liposomal daunorubicin | Seems not superior |
Gill et al. 1996 described doses but did not clearly say in the paper when these drugs were given, but this schedule is assumed based on the Northfelt et al. 1998 ABV regimen. To our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Doxorubicin (Adriamycin) 10 mg/m2 IV once on day 1
- Bleomycin (Blenoxane) 15 units IV once on day 1
- Vincristine (Oncovin) 1 mg IV once on day 1
Supportive medications
- "No routine premedication was established by the protocol, but it could be provided at the discretion of the investigator"
14-day cycle for minimum of 2 cycles; given until complete remission, unacceptable toxicity, disease progression, patient refusal, or death
Variant #2, 20/10/1
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Northfelt et al. 1998 | Phase III (C) | Pegylated liposomal doxorubicin | Inferior ORR |
Note: to our knowledge, this regimen was not tested as an experimental arm in an RCT prior to becoming a standard comparator arm.
Chemotherapy
- Doxorubicin (Adriamycin) 20 mg/m2 IV once on day 1
- Bleomycin (Blenoxane) 10 mg/m2 IV once on day 1
- Vincristine (Oncovin) 1 mg IV once on day 1
Supportive medications
- "Colony-stimulating factors (CSFs) were prescribed at the discretion of the investigators."
14-day cycle for up to 6 cycles
References
- Gill PS, Wernz J, Scadden DT, Cohen P, Mukwaya GM, von Roenn JH, Jacobs M, Kempin S, Silverberg I, Gonzales G, Rarick MU, Myers AM, Shepherd F, Sawka C, Pike MC, Ross ME. Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi's sarcoma. J Clin Oncol. 1996 Aug;14(8):2353-64. link to original article contains verified protocol PubMed
- Northfelt DW, Dezube BJ, Thommes JA, Miller BJ, Fischl MA, Friedman-Kien A, Kaplan LD, Du Mond C, Mamelok RD, Henry DH. Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi's sarcoma: results of a randomized phase III clinical trial. J Clin Oncol. 1998 Jul;16(7):2445-51. link to original article contains verified protocol PubMed
Bevacizumab monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Uldrick et al. 2012 | Phase II |
Loading dose
- Bevacizumab (Avastin) 15 mg/kg IV once as a loading dose; start regular therapy 7 days later after this loading dose
Regular therapy
- Bevacizumab (Avastin) 15 mg/kg IV once on day 1
Supportive medications
- "Antihypertensive therapy was initiated for systolic blood pressure greater than 160 mmHg or diastolic blood pressure greater than 95 mmHg persisting for more than 1 week or for systolic blood pressure greater than 210 mmHg or diastolic blood pressure greater than 120 mmHg at any time."
- "HIV-positive patients with CD4 count of less than 200 cells/µL received Pneumocystis jiroveci prophylaxis."
- "Mycobacterium avium prophylaxis was considered if CD4 count was less than 75 cells/µL."
- Patients with HIV/AIDS continued HAART
- Filgrastim (Neupogen) "used as clinically indicated"
21-day cycles, given until progression of disease requiring cytotoxic therapy, lack of adherence to protocol (including HAART), or patient-requested discontinuation
References
- Uldrick TS, Wyvill KM, Kumar P, O'Mahony D, Bernstein W, Aleman K, Polizzotto MN, Steinberg SM, Pittaluga S, Marshall V, Whitby D, Little RF, Yarchoan R. Phase II study of bevacizumab in patients with HIV-associated Kaposi's sarcoma receiving antiretroviral therapy. J Clin Oncol. 2012 May 1;30(13):1476-83. Epub 2012 Mar 19. link to original article contains verified protocol link to PMC article PubMed
Daunorubicin liposomal monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Presant et al. 1993 | Phase II | ||
Gill et al. 1996 | Phase III (E) | ABV | Seems not superior |
Note: Gill et al. 1996 stopped treatment if CR was achieved.
Chemotherapy
- Daunorubicin liposomal (DaunoXome) 40 mg/m2 IV over 30 to 60 minutes once on day 1
Supportive medications
- "No routine premedication was established by the protocol, but it could be provided at the discretion of the investigator"
14-day cycles
References
- Presant CA, Scolaro M, Kennedy P, Blayney DW, Flanagan B, Lisak J, Presant J. Liposomal daunorubicin treatment of HIV-associated Kaposi's sarcoma. Lancet. 1993 May 15;341(8855):1242-3. link to original article PubMed
- Gill PS, Wernz J, Scadden DT, Cohen P, Mukwaya GM, von Roenn JH, Jacobs M, Kempin S, Silverberg I, Gonzales G, Rarick MU, Myers AM, Shepherd F, Sawka C, Pike MC, Ross ME. Randomized phase III trial of liposomal daunorubicin versus doxorubicin, bleomycin, and vincristine in AIDS-related Kaposi's sarcoma. J Clin Oncol. 1996 Aug;14(8):2353-64. link to original article contains verified protocol PubMed
Doxorubicin pegylated liposomal monotherapy
back to top |
Regimen
Study | Evidence | Comparator | Efficacy |
---|---|---|---|
Northfelt et al. 1998 | Phase III (E) | ABV | Superior ORR |
Chemotherapy
- Pegylated liposomal doxorubicin (Doxil) 20 mg/m2 IV over 30 minutes once on day 1
Supportive medications
- "Colony-stimulating factors (CSFs) were prescribed at the discretion of the investigators."
14-day cycle for up to 6 cycles
References
- Northfelt DW, Dezube BJ, Thommes JA, Miller BJ, Fischl MA, Friedman-Kien A, Kaplan LD, Du Mond C, Mamelok RD, Henry DH. Pegylated-liposomal doxorubicin versus doxorubicin, bleomycin, and vincristine in the treatment of AIDS-related Kaposi's sarcoma: results of a randomized phase III clinical trial. J Clin Oncol. 1998 Jul;16(7):2445-51. link to original article contains verified protocol PubMed
Etoposide monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Evans et al. 2002 | Phase II |
Chemotherapy
- Etoposide (Vepesid) 50 mg PO once per day on days 1 to 7
14-day cycles
References
- Evans SR, Krown SE, Testa MA, Cooley TP, Von Roenn JH. Phase II evaluation of low-dose oral etoposide for the treatment of relapsed or progressive AIDS-related Kaposi's sarcoma: an AIDS Clinical Trials Group clinical study. J Clin Oncol. 2002 Aug 1;20(15):3236-41. link to original article contains verified protocol PubMed
Paclitaxel monotherapy
back to top |
Regimen
Study | Evidence |
---|---|
Saville et al. 1995 | Phase II |
Chemotherapy
- Paclitaxel (Taxol) 135 mg/m2 IV over 3 hours once on day 1
21-day cycles
References
- Saville MW, Lietzau J, Pluda JM, Feuerstein I, Odom J, Wilson WH, Humphrey RW, Feigal E, Steinberg SM, Broder S, Yarchoan R, Odom J, Feuerstein I. Treatment of HIV-associated Kaposi's sarcoma with paclitaxel. Lancet. 1995 Jul 1;346(8966):26-8. link to original article contains protocol PubMed