Antiangiogenetic therapy with pioglitazone, rofecoxib, and metronomic trofosfamide in patients with advanced malignant vascular tumors.
BACKGROUND
Systemic therapy options for patients with advanced angiosarcomas are limited, and their prognosis is poor. The idea of angiostatic therapy following the paradigm of metronomic dosed chemotherapeutics combined with proapoptotic biomodulators had not been considered previously in these patients. Therefore, in a pilot study, the efficacy of metronomically scheduled, low-dose trofosfamide in combination with the peroxisome proliferator-activated receptor gamma agonist, pioglitazone, and the selective cyclooxygenase-2 inhibitor, rofecoxib, was evaluated in patients with advanced vascular malignancies.


METHODS
Six patients with advanced and pretreated but progressive, malignant vascular tumors (5 angiosarcomas and 1 hemangioendothelioma) received a combination of pioglitazone (45 mg per day orally) plus rofecoxib (25 mg per day orally) and, after 14 days, trofosfamide (3 x 50 mg per day orally). The therapy was administered continuously until progression was observed. If necessary, doses were modified according to side effects.


RESULTS
Two patients responded with complete remission of disease, one patient responded with partial remission, and three patients achieved stabilization of disease (no change). The median progression-free survival was 7.7 months (range, 2-15 months). Side effects generally were mild (World Health Organization Grade 1-2). Hospitalization was not necessary.


CONCLUSIONS
This new triple combination of low-dose metronomic trofosfamide, pioglitazone, and rofecoxib may represent a feasible new alternative in the palliative treatment of patients with advanced malignant vascular tumors.
Department of Dermatology, University of Regensburg, Regensburg, Germany. thomas.vogt@klinik.uni-regensburg.de
Thomas
T
Vogt
Christian
C
Hafner
Klaus
K
Bross
Frauke
F
Bataille
Karl-Walter
KW
Jauch
Anna
A
Berand
Michael
M
Landthaler
Reinhard
R
Andreesen
Albrecht
A
Reichle
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects / Q000494:pharmacology*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D003520:Cyclophosphamide / Q000008:administration & dosage / Q000031:analogs & derivatives*; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006390:Hemangioendothelioma / Q000188:drug therapy* / Q000473:pathology; D006394:Hemangiosarcoma / Q000188:drug therapy* / Q000473:pathology; D006801:Humans; D007783:Lactones / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D000077205:Pioglitazone; D013450:Sulfones; D045162:Thiazolidinediones / Q000008:administration & dosage; D016896:Treatment Outcome
D020533:Angiogenesis Inhibitors; D007783:Lactones; D013450:Sulfones; D045162:Thiazolidinediones; C116926:rofecoxib; D003520:Cyclophosphamide; C003726:trofosfamide; D000077205:Pioglitazone