Document Type : Case reports


1 Department of Colorectal Surgery, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China

2 Department of Pathology, School of Medicine, Sir Run Run Shaw Hospital, Zhejiang University, Hangzhou, China


Introduction: Primary colorectal angiosarcoma is a highly rare malignant tumor. There is no standard treatment method for this disease. No treatment of rectal angiosarcoma with apatinib has been reported so far.
Case Presentation: In the current study, an 87-year-old male presented with the symptoms of frequent defecation for more than one month in Hangzhou, China, in 2018. The patient was initially diagnosed with a rectal stromal tumor. The patient underwent ultrasound-guided transrectal mass puncture in the next treatment. However, immunohistochemical examinations confirmed the initial diagnosis of rectal angiosarcoma. The patient had advanced age and rectal angiosarcoma with metastasis; he had no surgical indications, and we tried to use apatinib 250 mg/d treatment to control the progression of the lesion. Then, he received apatinib, a novel tyrosine kinase inhibitor of vascular endothelial growth factor receptor-2 (VEGFR-2). The patient has been stable to apatinib with a dose of 250 mg daily by now.
Conclusions: Apatinib may play an important role in the treatment of unresectable angiosarcoma.


  1. Brown CJ, Falck VG, MacLean A. Angiosarcoma of the colon and rectum: report of a case and review of the literature. Dis Colon Rectum. 2004;47(12):2202-7. doi: 10.1007/s10350-004-0698-5. [PubMed: 15657674].
  2. Buehler D, Rice SR, Moody JS, Rush P, Hafez GR, Attia S, et al. Angiosarcoma outcomes and prognostic factors: a 25-year single institution experience. Am J Clin Oncol. 2014;37(5):473-9. doi: 10.1097/COC.0b013e31827e4e7b. [PubMed: 23428947]. [PubMed Central: PMC3664266].
  3. Yang L, Liu L, Han B, Han W, Zhao M. Apatinib treatment for KIT- and KDR-amplified angiosarcoma: a case report. BMC Cancer. 2018;18(1):618. doi: 10.1186/s12885-018-4523-2. [PubMed: 29855279]. [PubMed Central: PMC5984462].
  4. Lo YM, Gillett MB, Vina M, Collin J, Fleming KA. Hemangiosarcoma of the rectum after chronic anorectal ulceration. J Clin Gastroenterol. 1989;11(1):77-81. doi: 10.1097/00004836-198902000-00020. [PubMed: 2921494].
  5. Hinterseher I, Pistorius S, Zietz C, Bergert H. Epithelioid hemangiosarcoma of the rectum. Int J Colorectal Dis. 2005;20(4):385-7. doi: 10.1007/s00384-004-0673-6. [PubMed: 15959792].
  6. Maki RG, D'Adamo DR, Keohan ML, Saulle M, Schuetze SM, Undevia SD, et al. Phase II study of sorafenib in patients with metastatic or recurrent sarcomas. J Clin Oncol. 2009;27(19):3133-40. doi: 10.1200/jco.2008.20.4495. [PubMed: 19451436]. [PubMed Central: PMC2716936].
  7. Aljabab AS, Nason RW, Kazi R, Pathak KA. Head and neck soft tissue sarcoma. Indian journal of surgical oncology. 2011;2(4):286-90. doi: 10.1007/s13193-012-0127-5. [PubMed: 23204783].
  8. Taxy JB, Battifora H. Angiosarcoma of the gastrointestinal tract. A report of three cases. Cancer. 1988;62(1):210-6. doi: 10.1002/1097-0142(19880701)62:1<210::aid-cncr2820620132>;2-8. [PubMed: 3383117].
  9. Allison KH, Yoder BJ, Bronner MP, Goldblum JR, Rubin BP. Angiosarcoma involving the gastrointestinal tract: a series of primary and metastatic cases. Am J Surg Pathol. 2004;28(3):298-307. doi: 10.1097/00000478-200403000-00002. [PubMed: 15104292].
  10. DiSario JA, Burt RW, Kendrick ML, McWhorter WP. Colorectal cancers of rare histologic types compared with adenocarcinomas. Dis Colon Rectum. 1994;37(12):1277-80. eng. doi: 10.1007/bf02257796. [PubMed: 7995158].
  11. Young RJ, Brown NJ, Reed MW, Hughes D, Woll PJ. Angiosarcoma. Lancet Oncol. 2010;11(10):983-91. doi: 10.1016/s1470-2045(10)70023-1. [PubMed: 20537949].
  12. Delvaux V, Sciot R, Neuville B, Moerman P, Peeters M, Filez L, et al. Multifocal epithelioid angiosarcoma of the small intestine. Virchows Arch. 2000;437(1):90-4. doi: 10.1007/s004280000183. [PubMed: 10963385].
  13. Singla S, Papavasiliou P, Powers B, Gaughan J, von Mehren M, Watson JC, et al. Challenges in the treatment of angiosarcoma: a single institution experience. Am J Surg. 2014;208(2):254-9. doi: 10.1016/j.amjsurg.2014.01.007. [PubMed: 24811931].
  14. Naka N, Ohsawa M, Tomita Y, Kanno H, Uchida A, Myoui A, et al. Prognostic factors in angiosarcoma: a multivariate analysis of 55 cases. J Surg Oncol. 1996;61(3):170-6. doi: 10.1002/(sici)1096-9098(199603)61:3<170::Aid-jso2>3.0.Co;2-8. [PubMed: 8637202].
  15. Mehren MV, Randall R, Benjamin RS, Boles S, Jillian L. Scavone. Soft Tissue Sarcoma, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network Jnccn. 2018;16(5):536.
  16. Mark RJ, Poen JC, Tran LM, Fu YS, Juillard GF. Angiosarcoma. A report of 67 patients and a review of the literature. Cancer. 1996;77(11):2400-6. doi: 10.1002/(SICI)1097-0142(19960601)77:11<2400::AID-CNCR32>3.0.CO;2-Z. [PubMed: 8635113].
  17. Budd GT. Management of angiosarcoma. Curr Oncol Rep. 2002;4(6):515-9. doi: 10.1007/s11912-002-0066-3. [PubMed: 12354365].
  18. Ravi V, Sanford EM, Wang WL, Ross JS, Ramesh N, Futreal A, et al. Antitumor Response of VEGFR2- and VEGFR3-Amplified Angiosarcoma to Pazopanib. J Natl Compr Canc Netw. 2016;14(5):499-502. [PubMed: 27160228].
  19. Zhang H. Apatinib for molecular targeted therapy in tumor. Drug Des Devel Ther. 2015;9:6075-81. doi: 10.2147/DDDT.S97235. [PubMed: 26622168]. [PubMed Central: PMC4654530].
  20. Liu S, Su Lingfei, Mu Xuri, Shi Yubo, Zhang Aifeng, Ge Xingping. Apatinib inhibits macrophage-mediated epithelial–mesenchymal transition in lung cancer. RSC Advances. 2018;8(38):21451-9. doi: 10.1039/C8RA01231H.
  21. Roviello G, Ravelli A, Polom K, Petrioli R, Marano L, Marrelli D, et al. Apatinib: A novel receptor tyrosine kinase inhibitor for the treatment of gastric cancer. Cancer Lett. 2016;372(2):187-91. doi: 10.1016/j.canlet.2016.01.014. [PubMed: 26797419].
  22. Kou P, Zhang Y, Shao W, Zhu H, Zhang J, Wang H, et al. Significant efficacy and well safety of apatinib in an advanced liver cancer patient: a case report and literature review. Oncotarget. 2017;8(12):20510-5. doi: 10.18632/oncotarget.14724. [PubMed: 28103584]. [PubMed Central: PMC5386780].
  23. Li F, Liao Z, Zhao J, Zhao G, Li X, Du X, et al. Efficacy and safety of Apatinib in stage IV sarcomas: experience of a major sarcoma center in China. Oncotarget. 2017;8(38):64471-80. doi: 10.18632/oncotarget.16293. [PubMed: 28969086]. [PubMed Central: PMC5610018].
  24. Zhu B, Li J, Xie Q, Diao L, Gai L, Yang W. Efficacy and safety of apatinib monotherapy in advanced bone and soft tissue sarcoma: An observational study. Cancer Biol Ther. 2018;19(3):198-204. doi: 10.1080/15384047.2017.1416275. [PubMed: 29261005]. [PubMed Central: PMC5790336].