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

Authors Peng Y, Cui H, Liu Z, Liu D, Liu F, Song Y, Duan H, Qiu Y, Li Q

Received 23 December 2016

Accepted for publication 25 March 2017

Published 26 April 2017 Volume 2017:10 Pages 2289—2295

DOI https://doi.org/10.2147/OTT.S130990

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Akshita Wason

Peer reviewer comments 3

Editor who approved publication: Dr Carlos Vigil Gonzales

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

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