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Background: Angiosarcomas are rare high-grade aggressive vascular malignancies of endothelial cell origin which account for approximately 1% of all soft tissue sarcomas and have a poor prognosis. The cornerstone of treatment is a large en bloc resection with negative margins, when feasible. However, the aggressive behavior, the diffuse pattern and the clinically undetectable spread of the disease makes a complete resection very difficult to achieve. At presentation, inoperable or metastatic disease is common. A phase II study has demonstrated clinical benefit and reasonable tolerance to treatment with paclitaxel. Case presentation: A 68 year old man presented with facial angiosarcoma. After a multidisciplinary evaluation, the disease was considered locally advanced and not amenable to curative-intent surgery. Weekly paclitaxel was chosen as first-line treatment, starting on October 2009. Partial response was achieved after approximately 2 months of chemotherapy. Ten months later systemic treatment was stopped and the patient was evaluated by the radiation oncologist, a total dose of 60 Gy was delivered. Two months later, a rapidly progressing cutaneous recurrence in the irradiated area with nasal bleeding was noted. Due to the previous prompt and excellent response, treatment with paclitaxel was resumed, using the same weekly schedule. Again, partial response was achieved. At that point, it was reasonable to plan a long-term maintenance treatment with tailored schedule; paclitaxel was administered every 2 weeks. After more than 4 years of maintenance therapy, with an interval between consecutive administrations of no longer than 2 weeks, the patient is still in almost complete remission. Conclusion: We report long-term survival of a patient treated with tailored paclitaxel regimen which enabled the improvement of the therapeutic index and reduced toxicities.

Background: Cervical cancer (CC) represents the second most commonly diagnosed cancer in women. The combined treatment involving C and R has been the standard treatment for stages IIB-IIIB. However the results are still disappointing with 5-year survival rates lower than 50%. There is a great need to explore new strategies in order to improve the prognosis of these patients. E inhibits the mammalian target of rapamycin (mTOR). The high aberrant activity of mTOR complexes is part of the underlying cause of carcinogenesis in CC. Further E inactivates the oncoprotein E7 (essential in the carcinogenesis of HPV) and inhibits its proliferation. Preclinical models have suggested that mTOR inhibitors sensitize tumoral cells and vasculature to C and R effects. Therefore mTOR inhibition may represent a promising treatment approach in CC. Methods: The primary objective of this trial is to evaluate the safety, toxicity (according to NCI CTCAE 3.0) and the maximum tolerated dose (MTD) of E in association to C and R in the treatment of locally advanced CC. The secondary objectives are to quantify PK and PD parameters, and to evaluate the response rate (using RECIST 1.1). In a modified Fibonacci design the trial aims to evaluate three cohorts of at least three patients treated with daily escalating doses of E (2.5/5/10 mg) in association with C (40 mg/m2 of body surface per week, for 5 weeks during teletherapy) and R (teletherapy - 4.500 cGy in 25 fractions, followed by 4 fractions of 600 cGy weekly of brachytherapy - B) in squamous cell cervical carcinoma patients stage IIB to IIIB. Patients are treated with E from day -7 to day 0 (one week before the C+R starting) up to the last day of B. Results: As of December 01, 2013, 13 patients were enrolled, 6 in the cohort #1, 3 in the cohort #2 and 4 in the cohort #3. Two patients did not completed the planned schedule, one at dose level of 2,5 mg presented grade 4 acute renal failure interpreted as dose limiting toxicity (DLT) and one at dose level of 10 mg with disease progression. Grade 3 toxicity occurred in cohorts #1 and #2 as follows: lymphopenia in 6 patients, neutropenia in 3 patients and leukopenia in 1 patient. Three patients in the cohort #3 are still on treatment. PK and PD studies will be performed together, after collection of the entire set of samples. Conclusions: The end of treatment of the last cohort is due to February 2014, when the MTD will be established. To the best of our knowledge this is the first study of everolimus, cisplatin and pelvic radiotherapy combination. Citation Format: Carlos Gil Ferreira, Flávia V. Guerra Alves, Rachele Grazziotin, Felipe Erlich, Giulliana Moralez, Michel P. Carneiro, Mariane Fontes Dias, Andréia C. de Melo. A Phase I study of oral administration of mTOR inhibitor everolimus (E) in association with cisplatin (C) and radiotherapy (R) for the treatment of locally advanced cervix cancer (LACC) - PHOENIX I. [abstract]. In: Proceedings of the 105th Annual Meeting of the American Association for Cancer Research; 2014 Apr 5-9; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2014;74(19 Suppl):Abstract nr CT403. doi:10.1158/1538-7445.AM2014-CT403

Aim: Cervical cancer is the third most commonly diagnosed cancer and the fourth leading cause of cancer deaths in women around the world. Human papilloma virus (HPV) infection is considered necessary factor for the development of cervical cancer and it is identified in 99.7% of cases. The main route of HPV transmission is sexual, and factors such as multiple partners and early onset of sexual activity favors infection and transmission. The incidence of cervical cancer in HIV-positive women is high and it is a defining disease of immunodeficiency syndrome (AIDS). These women also have more aggressive disease that is less responsive to the standard therapy. Viral hepatitis B and C, as well as HIV infection, are sexually transmitted diseases and they share similar risk factors to those of cervical cancer. In the case of hepatitis, they have great importance to public health because of their high prevalence, incidence and possible complications of acute and chronic forms. The objective of this study is to evaluate the prevalence of HIV, hepatitis B and C infection in patients with cervical cancer. Methods: A retrospective search of the database at the Brazilian National Cancer Institute was performed, and all patients diagnosed with cervical cancer between October 2009 and December 2012 and the results of serological tests for HIV, hepatitis B and C infection were analyzed. Results: A total of 1659 women were enrolled. Squamous cervical cancer was diagnosed in 78.6%, adenocarcinoma in 16.8% and less frequent histological subtypes in 4.6%. The median age for first sexual intercourse was 17 years. Number of sexual partners (median) was 3. Positivity for HIV infection was identified in 0.98% (12 patients in 1222 tested). Between patients tested for hepatitis B (n = 1342), positivity for anti-HBc-IgG was 13.85% (n = 186), indicating previous contact with hepatitis virus B. For hepatitis C, 2.18% (n = 31) of the group tested (n = 1422) had anti-HCV positive, and hepatitis C was identified in 15 cases by a confirmatory test. Conclusions: Although the low prevalence of HIV infection, and hepatitis B and C in the cohort analyzed, the possibility of such co-infections should always be evaluated, since those diseases share routes of transmisson and prognosis could be influenced. Disclosure: All authors have declared no conflicts of interest.