Giant Fungated Locally Advanced Breast Carcinoma Responded to Hypofractionated Radiotherapy Combined with Apatinib: A Case Report and Literature Review

Liu, Hui; Liu, Bailong; Ma, You-Zhi; Guo, Liang; Wu, Di; Shi, Aiping; Liu, Min

doi:10.2147/cmar.s291029

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…The dressing on the wound was changed frequently and this seriously affected the quality of life of the patient. After conducting a literature review, we found that a similar phenomenon occurred in some other cases [7,18–20]. We suggest that this may be related to the mechanism of action of Apatinib, as it induced apoptosis and inhibits cell proliferation by blocking the VEGF pathway.…”

Section: Introductionsupporting

confidence: 62%

“…But due to the significant anticancer of Apatinib, a large cavity formed rapidly in the primary tumor after the size of the tumor reduced, and this is not the first report of such an occurrence. A few case reports have also mentioned a similar phenomenon [7,[18][19][20], and we summarize have these cases in Table 1. Surgery or RT is generally palliative when cavities and necrosis occur.…”

Section: Discussionmentioning

confidence: 82%

“…Yee et al [21] reported that in cases of unresectable locally-ABC, ulceration and bleeding improved following RT in 13 (54%) of the 24 applicable cases. Liu [20] reported that the cavity gradually healed after hypofractionated irradiation of 40 Gy/8 fractions was delivered to the tumor. In our patient, the cavity became progressively smaller after endocrine therapy was commenced; however, she was not cured after 4 months of treatment, but the wound finally healed after RT.…”

Section: Discussionmentioning

confidence: 99%

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The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review

Lv¹,

Chen²,

Yi³

et al. 2021

Anti-Cancer Drugs

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Advanced breast cancer (ABC) is incurable. Previous studies have shown that vascular endothelial growth factor (VEGF) inhibitors play a significant role in the angiogenesis of breast carcinoma. Apatinib, a highly selective orally administered small-molecule tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor-2 (VEGFR2) has successfully been used as a second- and third-line agent in the management of ABC. There are also multiple reported cases where Apatinib was miraculously effective in the management of triple-negative and HER2-positive tumors. However, case reports of its effectiveness against luminal-type tumors are rare. Here, we report the case of a 34-year-old woman with hormone receptor-positive and HER2-negative ABC who was successfully treated with low-dose Apatinib. Owing to necrosis of the center of the tumor due to the effective anticancer effect of Apatinib, a large cavity formed rapidly in the primary lesion; thus, the quality of life of the patient was seriously affected. This report aims to caution physicians about this unique phenomenon when using Apatinib in clinical practice.

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Section: Introductionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review

Lv¹,

Chen²,

Yi³

et al. 2021

Anti-Cancer Drugs

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“…Importantly, apatinib can normalize the surviving tumor vessels, improve the delivery of chemotherapy drugs through reducing the pressure between tumor tissues, and enhance the efficacy of chemotherapy 32 . Recently, the efficacy of apatinib in advanced TNBC with failure of chemoradiotherapy has been confirmed in several studies [33][34][35] . In a retrospective study, combination of apatinib and capecitabine achieved a better PFS and tolerable toxicity compare with capecitabine monotherapy, which may regard as one of the options of the third-line treatment for advanced TNBC 36 .…”

Section: Yesmentioning

confidence: 99%

Apatinib plus vinorelbine versus vinorelbine for metastatic triple-negative breast cancer who failed first/second-line treatment: the NAN trial

Tao

Wang

et al. 2022

npj Breast Cancer

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While therapies such as chemotherapy combined with immunotherapy, sacituzumab govitecan, and PARP inhibitors are available for metastatic TNBC, on disease progression after these therapies, the mainstay of therapy is chemotherapy. Apatinib is a small-molecule tyrosine kinase inhibitor that has promising anti-angiogenesis and antitumor activity for TNBC. We aimed to evaluate the safety and efficacy of adding apatinib to chemotherapy in patients with advanced TNBC with failed first/second-line treatment. A total of 66 patients were randomly assigned, in a 1:1 ratio, to receive vinorelbine or vinorelbine with apatinib in 28-day cycles. The primary endpoint was progression-free survival (PFS). Secondary endpoints included overall survival (OS), overall response rate (ORR) and safety. 33 received apatinib plus vinorelbine and 32 received vinorelbine (1 was withdrawal). Median PFS was significantly longer in the apatinib plus vinorelbine group than in the vinorelbine group (3.9 months vs. 2.0 months; hazard ratio, 1.82; 95% confidence interval [CI], 1.06 to 3.11; P = 0.026). Median OS was 11.5 months with apatinib plus vinorelbine and 9.9 months with vinorelbine (HR,1.01; 95% CI, 0.51 to 1.97; P = 0.985). The ORR was 9.1% in the apatinib plus vinorelbine group and 6.3% in the vinorelbine group (P = 0.667). The most common treatment-related hematologic grade 3–4 adverse events in apatinib plus vinorelbine group, were leukopenia, granulocytopenia, anemia, and thrombocytopenia. no treatment-related nonhematologic grade 4 adverse events or treatment-related deaths were observed. Collectively, adding apatinib to vinorelbine shows a promising benefit in PFS compared to vinorelbine monotherapy, with an excellent toxicity profile, warranting further exploration.

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“…In recent years, apatinib combined with radiotherapy has shown good survival benefits in the treatment of non-small cell lung cancer, breast cancer, liver cancer, and cervical cancer ( Zhang et al, 2018 ; Liu et al, 2021 ; Ma et al, 2021 ). At present, there have been as many as 25 clinical studies of apatinib combined with radiotherapy, and that number seems to be increasing ( http://clinicaltrials.gov/ ).…”

Section: Introductionmentioning

confidence: 99%

Effect of X-ray radiation on the pharmacokinetics of apatinib in vivo in rats

et al. 2022

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Purpose: The “radiotherapy-pharmacokinetic” (“RT-PK”) phenomenon refers to the fact that radiation can significantly alter the pharmacokinetic behavior of a drug. At present, it is not clear whether there is an “RT-PK” phenomenon that can affect apatinib during concurrent chemoradiotherapy. In this study, we used a rat irradiation model to study the effects of X-ray radiation on absorption, tissue distribution, and excretion of apatinib.Method: Healthy Sprague-Dawley (SD) rats were randomly divided into control and radiation groups. The radiation group was given an appropriate dose of abdominal X-ray radiation, while the control group was not given irradiation. After 24 h of recovery, both groups were given apatinib solution 45 mg/kg by gavage. A quantitative LC-MS/MS method was developed to determine the concentration of apatinib in the rats, so as to compare the differences between the control and radiation groups and thus investigate the modulating effect of radiation on the pharmacokinetics of apatinib in rats.Results: After abdominal X-ray irradiation, the area under the curve (AUC0-t) of apatinib in rat plasma decreased by 33.8% and 76.3% at 0.5 and 2 Gy, respectively. Clearance (CL) and volume of distribution (Vd) increased and were positively correlated with radiation dose. X-ray radiation significantly reduced the concentration of apatinib in the liver and small intestine, and there was no tissue accumulation. In excretion studies, we found that X-ray radiation reduced the cumulative excretion of apatinib in feces and urine by 11.24% and 86.17%, respectively.Conclusion: Abdominal X-ray radiation decreased plasma exposure, tissue distribution, and excretion of apatinib in rats, suggesting that the RT-PK phenomenon affects apatinib. We speculate that this RT-PK phenomenon is closely related to changes in metabolic enzymes in vivo. In clinical practice, when apatinib is combined with radiotherapy, attention should be paid to adjusting the dose of apatinib and optimizing the treatment plan to alleviate the adverse effects of this RT-PK phenomenon.

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Giant Fungated Locally Advanced Breast Carcinoma Responded to Hypofractionated Radiotherapy Combined with Apatinib: A Case Report and Literature Review

Cited by 5 publications

References 29 publications

The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review

The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review

Apatinib plus vinorelbine versus vinorelbine for metastatic triple-negative breast cancer who failed first/second-line treatment: the NAN trial

Effect of X-ray radiation on the pharmacokinetics of apatinib in vivo in rats

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