Durable efficacy of anlotinib in a patient with advanced thymic squamous cell carcinoma after multiline chemotherapy and apatinib: A case report and literature review

Abstract

Thymic carcinoma is a rare and highly aggressive mediastinal tumor. Most patients are diagnosed at surgically unresectable stages. Current prospective and retrospective studies have indicated that platinum and anthracycline‐based chemotherapy are the first choice drugs of first‐line therapy for advanced thymic carcinoma. However, there is no optimal treatment after progression for patients who have undergone first‐line and subsequent chemotherapy. Anlotinib, a novel small molecule tyrosine kinase multitarget inhibitor, was approved by the China Food and Drug Administration as a third‐line treatment for advanced non‐small cell lung cancer (NSCLC) in May 2018. Herein we report a case of an advanced thymic squamous cell carcinoma patient harboring EGFR exon 20 insertion who had previously received multiline therapy, including chemotherapy, radiotherapy as well as antiangiogenic therapy. Also as an angiogenesis inhibitor, anotinib had controlled his mediastinal mass after failure of the apatinib treatment. To date, over 23 months of progression‐free survival (PFS) and six years of overall survival (OS) have been achieved. Compared with apatinib, the adverse reactions have been mild and tolerable and the patient's quality of life has improved. To our knowledge, this is the first report where anlotinib has been effective in controlling the progression of thymic carcinoma. In the multiline treatment of advanced thymic carcinoma, anlotinib appears to show great potential when utilized as a salvage treatment.

Complete remission following icotinib administration in an advanced ectopic thymic carcinoma patient harbouring the EGFR exon 19 deletion

“…A previous report demonstrated a case of an advanced thymic squamous cell carcinoma patient harbouring an EGFR exon 20 insertion who achieved stable disease with grade 2 hypothyroidism. 22 Further investigations are warranted to ascertain whether icotinib is associated with a more favourable outcome for TC compared to that with other first‐generation EGFR‐TKIs. Acquired resistance to first‐generation EGFR‐TKIs is common, and several resistance mechanisms, including T790M, MET amplification, PIK3CA and BRAF mutations, have been reported in NSCLC.…”

Emerging therapies in thymic epithelial tumors (Review)

“…Anlotinib is highly selective for VEGF receptors VEGFR2 and VEGFR3 ( 40 , 41 ). A recent case report described the efficacy of anlotinib in a patient with refractory TC after multiple lines of chemotherapy as well as anti-angiogenic therapy with another multi-target TKI, apatinib ( 42 ). Apatinib is a highly selective TKI, which mainly competes with the ATP-binding site of VEGFR-2.…”

“…The patient was unable to tolerate the toxicity associated with apatinib and by the 13th month disease progressed ( 43 ). After the first anti-angiogenic TKI failed, anlotinib was well tolerated, without obvious AEs and the patient achieved a PFS of over 23 months; therefore, further clinical investigation of anlotinib is warranted ( 42 ). Moreover, lucitanib is an oral, potent selective inhibitor of VEGFR, PDGFR and fibroblast growth factor receptor (FGFR), which was evaluated in a phase Ib trial enrolling 15 patients with TM or TC.…”

An Overview on Molecular Characterization of Thymic Tumors: Old and New Targets for Clinical Advances

“…In respect to new antiangiogenic drugs, a recent case report described the efficacy of anlotinib, a multi-target tyrosine kinase inhibitor (TKI) that targets VEGFR, FGFR, PDGFR, and c-KIT, in a patient with refractory TC who achieved a SD with a PFS of 23 months [ 107 ]. However, more data is needed to assess the clinical utility of anlotinib in patients with TET.…”