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Apatinib in Patients with Relapsed or Refractory Diffuse Large B Cell Lymphoma: A Phase II, Open-Label, Single-Arm, Prospective Study

Authors Ma X, Li L, Zhang L, Fu X, Li X, Wang X, Wu J, Sun Z, Zhang X, Feng X, Chang Y, Zhou Z, Nan F, Zhang J, Li Z, Zhang M

Received 16 August 2019

Accepted for publication 17 December 2019

Published 22 January 2020 Volume 2020:14 Pages 275—284


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 2

Editor who approved publication: Professor Manfred Ogris

Xinran Ma,* Ling Li,* Lei Zhang, Xiaorui Fu, Xin Li, Xinhua Wang, Jingjing Wu, Zhenchang Sun, Xudong Zhang, Xiaoyan Feng, Yu Chang, Zhiyuan Zhou, Feifei Nan, Jieming Zhang, Zhaoming Li, Mingzhi Zhang

Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Center of Henan Province, Zhengzhou, Henan, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Mingzhi Zhang
Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Lymphoma Diagnosis and Treatment Centre of Henan Province, Zhengzhou 450002, Henan, People’s Republic of China
Tel +86-13838565629

Purpose: Treatment options for relapsed or refractory diffuse large B-cell lymphoma (RR DLBCL) represent an unmet medical need. Apatinib is a new oral tyrosine kinase inhibitor mainly targeting vascular endothelial growth factor receptor-2 (VEGFR-2) to inhibit tumour angiogenesis. In the present study, we evaluated the efficacy and safety of apatinib for patients with RR DLBCL.
Patients and Methods: In this phase II, open-label, single-arm, prospective study, we enrolled patients aged 14– 70 years with treatment failure of at least two chemotherapeutic regimens using Simon’s two-stage design. All patients were administered apatinib at an initial dose of 500 mg on a 4-week cycle at home and visited the outpatient clinic every two cycles to evaluate efficacy and to record adverse events. We considered objective response rate (ORR) as the primary end point, and progression-free survival (PFS), and overall survival (OS) plus duration of response (DoR) as the secondary end point. (This trial was registered at, identifier: NCT03376958.).
Results: From January 2017 to February 2019, we screened 35 patients and enrolled 32 eligible patients. At the cutoff point (April 2019), we noted 2 (6.3%) complete responses, 12 (37.5%) partial responses, and 9 (28.1%) stable diseases, attributing to an ORR of 43.8% and a disease control rate of 71.9%. The median PFS and OS were 6.9 (95% confidence interval [CI], 5.8– 7.9) and 7.9 months (95% CI, 7.0– 8.7), respectively. The median DoR was 5.0 months (95% CI, 3.5– 6.5) for patients who achieved PR. The most common grade 3– 4 adverse events (AE) were hypertension (12.6%), hand–foot syndrome (9.4%), and leucopenia (6.3%). No apatinib-related deaths were noted.
Conclusion: Home administration of apatinib shows promising efficacy and manageable AEs in patients with RR DLBCL.

Keywords: apatinib, relapsed or refractory diffuse large B-cell lymphoma, VEGFR-2, efficacy, safety

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