What treatment would you recommend for a patient with multi-focal angiosarcoma involving the gastrointestinal tract?

My answer would differ for a primary cutaneous angiosarcoma that has spread to the GI tract vs a primary visceral angiosarcoma. Outside of a clinical trial, for a young fit patient with a primary cutaneous angiosarcoma, taxane based chemotherapy would be my preferred option, usually weekly paclitaxel, but for especially aggressive tumors, I will use gemcitabine+docetaxel. For a primary visceral angiosarcoma, I generally give anthracycline based chemotherapy as the first systemic therapy. This wo...

Clearly an uncommon presentation - seen "more often" in HIV associated KS. One needs to be careful in looking out for a significant GI bleed or even a perforation as the tumors respond to chemotherapy. Starting with a less myelosuppressive regimen from the options listed to gain some control may be helpful, in case the patient needs emergent surgical attention.

Here is my n=1 of a long survivor of multifocal gut angiosarcoma.

1. 50-year-old presents with GI bleed 2/2013; 2 widely spaced foci of angiosarcoma in small bowel. Resected (with two anastomoses, preserving intervening bowel!). Imaging with widespread metastatic disease.
2. Enrolled in phase 3 study of ifosfamide analog TH-302+ doxorubicin and received both drugs. Progressed before cycle 2 at multiple sites including the scar from surgery. More surgery by a well-meaning surgeon confirming more sarco...