Apatinib to combat EGFR-TKI resistance in an advanced non-small cell lung cancer patient with unknown EGFR status: a case report

• Main Authors: Peng Y, Cui H, Liu Z, Liu D, Liu F, Song Y, Duan H, Qiu Y, Li Q
• Format: Article
• Language: English
• Published: Dove Medical Press 2017-04-01
• Series: OncoTargets and Therapy
• Subjects: advanced non-small cell lung cancer; apatinib; erlotinib; venous thromboembolism; dabigatran
• Online Access: https://www.dovepress.com/apatinib-to-combat-egfr-tki-resistance-in-an-advanced-non-small-cell-l-peer-reviewed-article-OTT

Yanmei Peng,1 Huijuan Cui,2 Zhe Liu,3 Daiwei Liu,1 Fan Liu,1 Yazhong Song,1 Hua Duan,1 Yuqin Qiu,1 Qiang Li1 1Department of China-Japan Friendship Hospital, Beijing University of Chinese Medicine, 2Department of Oncology, China-Japan Friendship Hospital, Chaoyang, 3Department of Oncology, Beijing Chest Hospital, Tongzhou, Beijing, People’s Republic of China Abstract: Lung adenocarcinoma is the most common pathological pattern of lung cancer. During the past decades, a number of targeted agents have been explored to treat advanced lung adenocarcinoma. In the present clinical practice, antagonists of the epidermal growth factor receptor (EGFR) and vascular endothelial growth factor (VEGF)-directed therapies are widely used. In the former category, the agent erlotinib (tyrosine kinase inhibitor) has shown obvious advantages over cytotoxic therapy. Anti-VEGF therapy bevacizumab used for lung adenocarcinoma was recommended in NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) as first-line therapy. Similarly, apatinib is speculated to response by selectively inhibiting the vascular endothelial growth factor receptor-2. The patient with unknown EGFR status benefited 5-month progressive free survival (PFS) from erlotinib, and then another 5.1-month PFS with combined treatment of apatinib, which suggested a new option for lung adenocarcinoma. However, when dabigatran was used to cancer-related venous thromboembolism during apatinib therapy, extensive subcutaneous bleeding occurred, warning us against the risks of bleeding. Besides, hypertension and anorexia were observed, causing dosage adjustment. Keywords: NSCLC, epidermal growth factor receptor, vascular endothelial growth factor, venous thromboembolism, dabigatran