Neoadjuvant β-blocker in angiosarcoma patients
Neoadjuvant trial on the efficacy of propranolol monotherapy in patients with angiosarcoma (PropAngio).
Why this trial?
Angiosarcoma is an aggressive and rare cancer type with a high risk of spreading (i.e. developing metastases). The standard treatment for localised angiosarcoma is to surgically remove the entire tumour, sometimes combined with radiation. However, despite optimal disease management approximately half of patients relapse.
Although the role of chemotherapy before or after surgery remains controversial for localised disease, neoadjuvant chemotherapy (before surgery) is often administered for locally advanced angiosarcoma. Several chemotherapies have shown activity in the locally advanced and metastatic setting but none have shown a beneficial effect in terms of prolonged survival or time to relapse when used in a neoadjuvant fashion among patients with operable angiosarcoma.
By improving the neoadjuvant treatment of this disease and effectively treating micro-metastases at an early stage, the number of local and distant recurrences might be reduced, potentially leading to higher survival rates. New drugs for the neoadjuvant setting for angiosarcoma are thus urgently needed.
Why this intervention?
Propranolol, a β-blocker, has recently been repurposed against a benign vascular tumour called haemangioma with 88% complete or near complete resolution of the treated lesions. Haemangiomas express high levels of β-adrenergic receptors potentially explaining their sensitivity to propranolol. These receptors are reported to be highly expressed in malignant vascular tumours suggesting the effect of propranolol and other β-blockers may extend to aggressive vascular tumours like angiosarcoma as well.
Several case reports have indeed suggested that propranolol could be repurposed to treat angiosarcoma. Patients with locally advanced or metastatic angiosarcoma have been treated with propranolol in combination with various chemotherapies. Also, a reduction in proliferation index and stabilisation of tumour growth of angiosarcoma in response to propranolol monotherapy has been reported in one patient.
Propranolol is an already approved drug with well-known pharmacokinetic properties and toxicity profile, and has been or is being used in more than 20 oncology trials, including one trial in advanced angiosarcoma.
This is a single-arm neoadjuvant window of opportunity phase II study to explore the activity of propranolol in angiosarcoma. Propranolol will be administered as monotherapy in a dose of 40-80 mg 2-3 times a day, if tolerated. 14 patients with newly diagnosed, recurrent or metastatic angiosarcoma will be recruited.
- Winan van Houdt, The Netherlands Cancer Institute, Amsterdam, The Netherlands (Coordinating Investigator)
- Neeltje Steeghs, The Netherlands Cancer Institute, Amsterdam, The Netherlands (Principal Investigator)
The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital (NKI-AVL)
ACF co-funding partners:
- Ockier & Partners Advocaten
- Vansteelandt BV - Plan 3D
More info: NL71090.031.19
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Heinhuis KM, IJzerman NS, Koenen AM, et al. PropAngio study protocol: a neoadjuvant trial on the efficacy of propranolol monotherapy in cutaneous angiosarcoma—a proof of principle study. BMJ Open 2020;10:e039449. doi:10.1136/bmjopen-2020-039449
Author: Kristine Beckers (Trial Manager)
Last updated: September 2020