Dramatic Recovery from Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma

Q: What is the clinical evidence from this study?

Study design: Case Report. Population: Primary right atrium cardiac angiosarcoma with hemodynamic instability and circulatory collapse (n=3). Intervention: Paclitaxel. Primary outcome: Resolution of hemodynamic instability/cardiac tamponade, tumor response, and improvement in ECOG performance status leading to hospital discharge.

Q: What does this research mean for the field?

Urgent weekly paclitaxel administration can resolve cardiac tamponade and hemodynamic collapse in patients with advanced primary cardiac angiosarcoma and poor performance status. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Toshio Suzuki; Yoshiyuki Yamamoto; Noriaki Sakamoto; Hideo Suzuki; Kazuko Tajiri; Tomoko Ishizu; Yasuhiro Fujisawa; Masayuki Noguchi; Masaki Ieda; Yuji Hiramatsu; Ikuo Sekine

doi:10.2169/internalmedicine.5420-20

August 21, 2020Internal MedicineOpen Access

Dramatic Recovery from Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma

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Key result

Weekly paclitaxel resolves cardiac tamponade and stabilizes hemodynamics in ~100% of reported cases.

n=3

Why the study?

No treatment guidelines for primary cardiac angiosarcoma have been established, particularly for patients presenting in the intensive-care unit with hemodynamic instability and poor performance status.

Does urgent weekly paclitaxel chemotherapy resolve hemodynamic instability and improve performance status in critically ill patients with unresectable primary cardiac angiosarcoma?

Key Points

To evaluate the feasibility and therapeutic efficacy of urgently initiated weekly paclitaxel in patients with primary cardiac angiosarcoma presenting with acute circulatory collapse and poor performance status.
Included N=3 consecutive patients admitted directly to the intensive care unit with advanced right atrial cardiac angiosarcoma and refractory cardiac tamponade.
Conducted prompt diagnostic evaluation using multidisciplinary cardio-oncologic assessment and invasive biopsy (open surgical or endocardial).
Administered urgent weekly paclitaxel at 100 mg/m² body surface area on days 1, 8, 15, 22, 29, and 36 of a 7-week cycle despite an Eastern Cooperative Oncology Group (ECOG) performance status of 4.
All 3 patients achieved rapid hemodynamic stabilization and resolution of life-threatening cardiac tamponade, enabling discharge from the hospital.
Treatment markedly improved functional capacity, with performance status improving from ECOG 4 to ECOG 1 in the first reported patient.
Tumor burden was substantially reduced (e.g., right atrial mass decreased from 65 mm to 15 mm partial response, with survival reaching 14.3 months following paclitaxel initiation in case 1).

Study Design

Type

Case Report (n=3)

Multicenter

No

Structured PICO

Does urgent weekly paclitaxel chemotherapy resolve hemodynamic instability and improve performance status in critically ill patients with unresectable primary cardiac angiosarcoma?

P

Population

3 adults (aged 38-39 years, 66.7% female) with advanced primary right atrial cardiac angiosarcoma, ECOG performance status 4, and hemodynamic instability due to cardiac tamponade, followed for 6 to 14.3 months.

I

Intervention

Urgent weekly paclitaxel chemotherapy at 100 mg/m2 body surface area on days 1, 8, 15, 22, 29, and 36 of a 7-week cycle, initiated following invasive histological biopsy.

O

Outcome

Stabilization of vital signs, resolution of refractory pericardial effusion and cardiac tamponade, reduction in tumor size (partial response on CT), and improvement in ECOG performance status permitting hospital discharge.hard clinical

Urgent weekly paclitaxel following invasive biopsy can rapidly reverse life-threatening cardiac tamponade and hemodynamic collapse in patients with unresectable primary cardiac angiosarcoma despite a poor baseline performance status.

Limitations

Small case series of only three consecutive patients
Lack of established treatment guidelines or randomized controlled trials evaluating taxanes against cardiac angiosarcomas
Need for further multi-institutional retrospective studies and prospective clinical trials
Very small sample size (3 cases)
Single-institution observational case series with no control group
No prospective trials or established guidelines exist for cardiac angiosarcoma

Implication

May support urgent paclitaxel in select unresectable cardiac angiosarcoma cases; hypothesis-generating and requires prospective validation.

Abstract

We herein report three patients with cardiac angiosarcoma who were directly admitted to the intensive-care unit for hemodynamic instability with circulatory collapse. Using a multidisciplinary cardio-oncologic approach, we diagnosed their condition as angiosarcoma by an invasive biopsy and urgently started weekly paclitaxel administration despite their poor performance status. Their vital signs were soon stabilized, leading to the patients' discharge from the hospital. Although no treatment guidelines for cardiac angiosarcoma have been established, chemotherapy with paclitaxel can be an option for cases presenting with hemodynamic instability.

Discussion

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Cite This Study

Suzuki et al. (2020) conducted a case report in Primary right atrium cardiac angiosarcoma with hemodynamic instability and circulatory collapse (n=3). Paclitaxel was evaluated on Resolution of hemodynamic instability/cardiac tamponade, tumor response, and improvement in ECOG performance status leading to hospital discharge. Weekly paclitaxel (100 mg/m2) resolved cardiac tamponade and hemodynamic instability in all 3 patients (100%), improving ECOG performance status from 4 to 1 and allowing hospital discharge.

synapsesocial.com/papers/6ade20629c2e6c671a9a5faa https://doi.org/10.2169/internalmedicine.5420-20

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Dramatic Recovery from Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Dramatic Recovery from Cardiovascular Collapse: Paclitaxel as an Urgent Treatment for Primary Cardiac Angiosarcoma

Key Points

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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