Case Report/Case Series
November 2015

Growth Attenuation of Cutaneous Angiosarcoma With Propranolol-Mediated β-Blockade

Author Affiliations
  • 1Mohs Micrographic Surgery and Cutaneous Oncology, San Leandro, California
  • 2Department of Biomedical Sciences, Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso
  • 3Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, St Paul
  • 4Masonic Cancer Center, University of Minnesota, Minneapolis

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JAMA Dermatol. 2015;151(11):1226-1229. doi:10.1001/jamadermatol.2015.2554

Importance  Patients with stage T2 multilesion angiosarcomas of the scalp and face that are larger than 10 cm demonstrate a 2-year survival rate of 0%. To our knowledge, major therapeutic advances against this disease have not been reported for decades. Preclinical data indicate that blocking β-adrenergic signaling with propranolol hydrochloride disrupts angiosarcoma cell survival and xenograft angiosarcoma progression.

Observations  A patient presented with a β-adrenergic–positive multifocal stage T2 cutaneous angiosarcoma (≥20 cm) involving 80% of the scalp, left forehead, and left cheek, with no evidence of metastasis. The patient was immediately administered propranolol hydrochloride, 40 mg twice a day, as his workup progressed and treatment options were elucidated. Evaluation of the proliferative index of the tumor before and after only 1 week of propranolol monotherapy revealed a reduction in the proliferative index of the tumor by approximately 34%. A combination of propranolol hydrochloride, 40 mg 3 times a day, paclitaxel, 2 mg/m2 infused weekly, and radiotherapy during the subsequent 8 months resulted in extensive tumor regression with no detectable metastases.

Conclusions and Relevance  Our data suggest that β-blockade alone substantially reduced angiosarcoma proliferation and, in combination with standard therapy, is effective for reducing the size of the tumor and preventing metastases. If successful, β-blockade could be the first major advancement in the treatment of angiosarcoma in decades.