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Published in: Journal of Cancer Research and Clinical Oncology 3/2014

01-03-2014 | Original Paper

Sirolimus, a promising treatment for refractory Kaposiform hemangioendothelioma

Authors: Li Kai, Zuopeng Wang, Wei Yao, Kuiran Dong, Xianmin Xiao

Published in: Journal of Cancer Research and Clinical Oncology | Issue 3/2014

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Abstract

Background

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor that usually occurs in infants. It is commonly associated with Kasabach–Merritt phenomenon which is directly responsible for the significant morbidity and mortality, including hemodynamic instability, local invasion, and compression of vital structures. Treatment is particularly difficult for those who had no response to conventional therapies. This paper wants to share experience of mTOR inhibitors sirolimus in the treatment of refractory KHE.

Materials and methods

Six cases of refractory KHE were diagnosed and treated in Children’s Hospital of Fudan University from Jan 2010–June 2013; all of them were treated with sirolimus in June 2012 after failing multiple other therapies.

Results

In six patients, gender was equally distributed between male and female patients. The mean age at the time of initial diagnosed as KHE was 3.1 ± 1.8 months. All of them had been pretreated with at least 2 medical therapies. All of them showed significant improvement in clinical status with tolerable side effects. The average time to response was 5.3 ± 1.0 days; the average stabilization time of platelet was 15.1 ± 8.0 days; and the average time for sirolimus treated as single agent was 1.7 ± 0.4 months. No recurrence of their symptoms happened.

Conclusions

Sirolimus appears to be effective and safe in patients with life-threatening KHE and represents a promising tool in treating refractory KHE.
Literature
go back to reference Alvarado Y et al (2011) Clinical activity of mammalian target of rapamycin inhibitors in solid tumors. Target Oncol 6(2):69–94PubMedCrossRef Alvarado Y et al (2011) Clinical activity of mammalian target of rapamycin inhibitors in solid tumors. Target Oncol 6(2):69–94PubMedCrossRef
go back to reference Castilho R, Squarize C, Gutkind J (2013) Exploiting PI3 K/mTOR signaling to accelerate epithelial wound healing. Oral Dis 19(6):551–558PubMedCrossRef Castilho R, Squarize C, Gutkind J (2013) Exploiting PI3 K/mTOR signaling to accelerate epithelial wound healing. Oral Dis 19(6):551–558PubMedCrossRef
go back to reference Croteau SE et al (2013) Kaposiform hemangioendothelioma: atypical features and risks of Kasabach–Merritt phenomenon in 107 referrals. J Pediatr 162(1):142–147PubMedCentralPubMedCrossRef Croteau SE et al (2013) Kaposiform hemangioendothelioma: atypical features and risks of Kasabach–Merritt phenomenon in 107 referrals. J Pediatr 162(1):142–147PubMedCentralPubMedCrossRef
go back to reference DeFatta RJ et al (2005) Kaposiform hemangioendothelioma: case report and literature review. Laryngoscope 115(10):1789–1792PubMedCrossRef DeFatta RJ et al (2005) Kaposiform hemangioendothelioma: case report and literature review. Laryngoscope 115(10):1789–1792PubMedCrossRef
go back to reference Deb G (2003) Kaposiform hemangioendothelioma and therapy with interferon-alpha. Med Pediatr Oncol 41(6):593PubMedCrossRef Deb G (2003) Kaposiform hemangioendothelioma and therapy with interferon-alpha. Med Pediatr Oncol 41(6):593PubMedCrossRef
go back to reference Debelenko LV et al (2005) D2-40 immunohistochemical analysis of pediatric vascular tumors reveals positivity in Kaposiform hemangioendothelioma. Mod Pathol 18(11):1454–1460PubMedCrossRef Debelenko LV et al (2005) D2-40 immunohistochemical analysis of pediatric vascular tumors reveals positivity in Kaposiform hemangioendothelioma. Mod Pathol 18(11):1454–1460PubMedCrossRef
go back to reference Dresse MF et al (1991) Successful treatment of Kasabach–Merritt syndrome with prednisone and epsilon-aminocaproic acid. Pediatr Hematol Oncol 8(4):329–334PubMedCrossRef Dresse MF et al (1991) Successful treatment of Kasabach–Merritt syndrome with prednisone and epsilon-aminocaproic acid. Pediatr Hematol Oncol 8(4):329–334PubMedCrossRef
go back to reference Fahrtash F, McCahon E, Arbuckle S (2010) Successful treatment of kaposiform hemangioendothelioma and tufted angioma with vincristine. J Pediatr Hematol Oncol 32(6):506–510PubMedCrossRef Fahrtash F, McCahon E, Arbuckle S (2010) Successful treatment of kaposiform hemangioendothelioma and tufted angioma with vincristine. J Pediatr Hematol Oncol 32(6):506–510PubMedCrossRef
go back to reference Falger JC et al (2006) Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy. Pediatr Transplant 10(5):565–569PubMedCrossRef Falger JC et al (2006) Conversion from calcineurin inhibitor to sirolimus in pediatric chronic allograft nephropathy. Pediatr Transplant 10(5):565–569PubMedCrossRef
go back to reference Fasolo A, Sessa C (2011) Current and future directions in mammalian target of rapamycin inhibitors development. Expert Opin Investig Drugs 20(3):381–394PubMedCrossRef Fasolo A, Sessa C (2011) Current and future directions in mammalian target of rapamycin inhibitors development. Expert Opin Investig Drugs 20(3):381–394PubMedCrossRef
go back to reference Flores MV et al (2010) Visualization of embryonic lymphangiogenesis advances the use of the zebrafish model for research in cancer and lymphatic pathologies. Dev Dyn 239(7):2128–2135PubMedCrossRef Flores MV et al (2010) Visualization of embryonic lymphangiogenesis advances the use of the zebrafish model for research in cancer and lymphatic pathologies. Dev Dyn 239(7):2128–2135PubMedCrossRef
go back to reference Fuchimoto Y et al (2012) Vincristine, actinomycin D, cyclophosphamide chemotherapy resolves Kasabach–Merritt syndrome resistant to conventional therapies. Pediatr Int 54(2):285–287PubMedCrossRef Fuchimoto Y et al (2012) Vincristine, actinomycin D, cyclophosphamide chemotherapy resolves Kasabach–Merritt syndrome resistant to conventional therapies. Pediatr Int 54(2):285–287PubMedCrossRef
go back to reference Garcia CD et al (2006) Conversion to sirolimus in pediatric renal transplantation recipients. Transplant Proc 38(6):1901–1903PubMedCrossRef Garcia CD et al (2006) Conversion to sirolimus in pediatric renal transplantation recipients. Transplant Proc 38(6):1901–1903PubMedCrossRef
go back to reference Garcia-Monaco R et al (2012) Kaposiform hemangioendothelioma with Kasabach–Merritt phenomenon: successful treatment with embolization and vincristine in two newborns. J Vasc Interv Radiol 23(3):417–422PubMed Garcia-Monaco R et al (2012) Kaposiform hemangioendothelioma with Kasabach–Merritt phenomenon: successful treatment with embolization and vincristine in two newborns. J Vasc Interv Radiol 23(3):417–422PubMed
go back to reference Haisley-Royster C et al (2002) Kasabach–Merritt phenomenon: a retrospective study of treatment with vincristine. J Pediatr Hematol Oncol 24(6):459–462PubMed Haisley-Royster C et al (2002) Kasabach–Merritt phenomenon: a retrospective study of treatment with vincristine. J Pediatr Hematol Oncol 24(6):459–462PubMed
go back to reference Hammill AM et al (2011) Sirolimus for the treatment of complicated vascular anomalies in children. Pediatr Blood Cancer 57(6):1018–1024PubMed Hammill AM et al (2011) Sirolimus for the treatment of complicated vascular anomalies in children. Pediatr Blood Cancer 57(6):1018–1024PubMed
go back to reference Hu B et al (1998) Kasabach–Merritt syndrome-associated kaposiform hemangioendothelioma successfully treated with cyclophosphamide, vincristine, and actinomycin D. J Pediatr Hematol Oncol 20(6):567–569PubMed Hu B et al (1998) Kasabach–Merritt syndrome-associated kaposiform hemangioendothelioma successfully treated with cyclophosphamide, vincristine, and actinomycin D. J Pediatr Hematol Oncol 20(6):567–569PubMed
go back to reference Huber S et al (2007) Inhibition of the mammalian target of rapamycin impedes lymphangiogenesis. Kidney Int 71(8):771–777PubMed Huber S et al (2007) Inhibition of the mammalian target of rapamycin impedes lymphangiogenesis. Kidney Int 71(8):771–777PubMed
go back to reference Issaka RB et al (2009) Vascular endothelial growth factors C and D induces proliferation of lymphangioleiomyomatosis cells through autocrine crosstalk with endothelium. Am J Pathol 175(4):1410–1420PubMed Issaka RB et al (2009) Vascular endothelial growth factors C and D induces proliferation of lymphangioleiomyomatosis cells through autocrine crosstalk with endothelium. Am J Pathol 175(4):1410–1420PubMed
go back to reference Jiang RS, Hu R (2012) Successful treatment of Kasabach–Merritt syndrome arising from kaposiform hemangioendothelioma by systemic corticosteroid therapy and surgery. Int J Clin Oncol 17(5):512–516PubMed Jiang RS, Hu R (2012) Successful treatment of Kasabach–Merritt syndrome arising from kaposiform hemangioendothelioma by systemic corticosteroid therapy and surgery. Int J Clin Oncol 17(5):512–516PubMed
go back to reference Kaylani S, Theos AJ, Pressey JG (2013) Treatment of infantile hemangiomas with sirolimus in a patient with PHACE syndrome. Pediatr Dermatol 30(6):e194–e197 Kaylani S, Theos AJ, Pressey JG (2013) Treatment of infantile hemangiomas with sirolimus in a patient with PHACE syndrome. Pediatr Dermatol 30(6):e194–e197
go back to reference Kobayashi S et al (2007) Rapamycin, a specific inhibitor of the mammalian target of rapamycin, suppresses lymphangiogenesis and lymphatic metastasis. Cancer Sci 98(5):726–733PubMed Kobayashi S et al (2007) Rapamycin, a specific inhibitor of the mammalian target of rapamycin, suppresses lymphangiogenesis and lymphatic metastasis. Cancer Sci 98(5):726–733PubMed
go back to reference Le Huu AR et al (2010) Expression of prox1, lymphatic endothelial nuclear transcription factor, in Kaposiform hemangioendothelioma and tufted angioma. Am J Surg Pathol 34(11):1563–1573PubMed Le Huu AR et al (2010) Expression of prox1, lymphatic endothelial nuclear transcription factor, in Kaposiform hemangioendothelioma and tufted angioma. Am J Surg Pathol 34(11):1563–1573PubMed
go back to reference Lopez V et al (2009) Successful management of Kaposiform hemangioendothelioma with Kasabach–Merritt phenomenon using vincristine and ticlopidine. Pediatr Dermatol 26(3):365–366PubMed Lopez V et al (2009) Successful management of Kaposiform hemangioendothelioma with Kasabach–Merritt phenomenon using vincristine and ticlopidine. Pediatr Dermatol 26(3):365–366PubMed
go back to reference Low IC, Yang RY, Symmans PJ (2013) Microscopic Kaposiform hemangioendothelioma with extensive lymphangiomatosis: an extraordinary example of an unusual entity. Int J Surg Pathol 21(3):297–302PubMed Low IC, Yang RY, Symmans PJ (2013) Microscopic Kaposiform hemangioendothelioma with extensive lymphangiomatosis: an extraordinary example of an unusual entity. Int J Surg Pathol 21(3):297–302PubMed
go back to reference Trenor CR (2011) Sirolimus for refractory vascular anomalies. Pediatr Blood Cancer 57(6):904–905PubMed Trenor CR (2011) Sirolimus for refractory vascular anomalies. Pediatr Blood Cancer 57(6):904–905PubMed
go back to reference Vinayak S, Carlson RW (2013) mTOR inhibitors in the treatment of breast cancer. Oncology (Williston Park), 27(1):38–44, 46, 48 passim Vinayak S, Carlson RW (2013) mTOR inhibitors in the treatment of breast cancer. Oncology (Williston Park), 27(1):38–44, 46, 48 passim
go back to reference Wander SA et al (2013) PI3K/mTOR inhibition can impair tumor invasion and metastasis in vivo despite a lack of antiproliferative action in vitro: implications for targeted therapy. Breast Cancer Res Treat 138(2):369–381PubMedCentralPubMed Wander SA et al (2013) PI3K/mTOR inhibition can impair tumor invasion and metastasis in vivo despite a lack of antiproliferative action in vitro: implications for targeted therapy. Breast Cancer Res Treat 138(2):369–381PubMedCentralPubMed
go back to reference Yasui N et al (2013) Kasabach–Merritt phenomenon: a report of 11 cases from a single institution. J Pediatr Hematol Oncol 35(7):554–558 Yasui N et al (2013) Kasabach–Merritt phenomenon: a report of 11 cases from a single institution. J Pediatr Hematol Oncol 35(7):554–558
Metadata
Title
Sirolimus, a promising treatment for refractory Kaposiform hemangioendothelioma
Authors
Li Kai
Zuopeng Wang
Wei Yao
Kuiran Dong
Xianmin Xiao
Publication date
01-03-2014
Publisher
Springer Berlin Heidelberg
Published in
Journal of Cancer Research and Clinical Oncology / Issue 3/2014
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI
https://doi.org/10.1007/s00432-013-1549-3

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