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Efficacy and Adverse Events of Apatinib Salvage Treatment for Refractory Diffuse Malignant Peritoneal Mesothelioma: A
Zhi-Ran Yang1, Yan-Dong Su1, Ru Ma1
1Department of Peritoneal Cancer Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China.
Objective:
To investigate the clinical efficacy and adverse events (AEs) of apatinib salvage treatment for diffuse malignant peritoneal mesothelioma (DMPM) that has failed to respond to the recommended treatments.
Methods:
27 patients with refractory DMPM were treated with apatinib at our center from April 2014 to October 2020, at the initial dose of 250 mg/d. The dose was reduced to 125 mg/d when serious adverse events (SAEs) occurred. 28-day was set as a treatment cycle. The frequency of follow up was once every 28 days. The efficacy evaluation was conducted according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria and the serum tumor markers before and after apatinib treatment. The safety assessment was performed with the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The primary endpoints were objective response rate (ORR) and disease control rate (DCR), and the secondary endpoints were AEs.
Results:
The 27 patients completed a median treatment-cycle of 15.0, ranging from 5.1 to 39.4 cycles. At the median follow-up of 14.3 (4.8-51.8) months, median overall survival (OS) was 59.4 months, median apatinib-treatment-related survival (ATRS) was 14.0 (4.8-36.8) months. Complete response (CR) was observed in 0 case (0.0%), partial response (PR) in 4 cases (14.8%), stable disease (SD) in 12 cases (44.4%), and progression disease (PD) in 11 cases (40.7%). The ORR was 14.8%, and DCR was 59.3%. The median serum CA125 values before and after apatinib treatment were 32.9 (7.0-4592.4) U/mL and 29.7 (6.1-4327.4) U/mL, respectively (P=0.009). The common AEs were hypertension (6/27; 22.2%), hand-foot syndrome (5/27; 18.5%), albuminuria (4/27; 14.8%), anemia (4/27; 14.8%), leukopenia (4/27; 14.8%), rash (2/27; 7.4%), fatigue (2/27; 7.4%), oral ulcers (2/27; 7.4%), hoarseness (2/27; 7.4%), nausea/vomiting (2/27; 7.4%), diarrhea (2/27; 7.4%), headache (1/27; 3.7%), and fever (1/27; 3.7%). The incidence rate of grade III/IV AEs was 16.2%.
Conclusions:
Apatinib is effective in treating refractory DMPM, with promising efficacy and acceptable safety.
Insights
Apatinib shows efficacy in treating diffuse malignant peritoneal mesothelioma (DMPM) that is resistant to standard treatments. This study found promising survival rates and manageable side effects in patients receiving apatinib salvage therapy.
Area of Science:
- Oncology
- Medical Research
Background:
- Diffuse malignant peritoneal mesothelioma (DMPM) is a rare and aggressive cancer.
- Treatment options for refractory DMPM are limited, necessitating investigation into novel therapeutic strategies.
Purpose of the Study:
- To evaluate the clinical effectiveness and safety of apatinib as a salvage treatment for patients with DMPM who have not responded to prior therapies.
- To assess objective response rate (ORR), disease control rate (DCR), overall survival (OS), and adverse events (AEs) associated with apatinib treatment.
Main Methods:
- A cohort of 27 patients with refractory DMPM received apatinib (250 mg/d, reduced to 125 mg/d for serious AEs) in 28-day cycles.
- Efficacy was assessed using RECIST 1.1 criteria and serum tumor markers; safety was evaluated per NCI CTCAE v5.0.
Main Results:
- A median follow-up of 14.3 months revealed a median OS of 59.4 months and a median apatinib-treatment-related survival (ATRS) of 14.0 months.
- The ORR was 14.8% (4 partial responses) and DCR was 59.3% (12 stable disease).
- Common AEs included hypertension (22.2%) and hand-foot syndrome (18.5%); grade III/IV AEs occurred in 16.2% of patients.
Conclusions:
- Apatinib demonstrates encouraging efficacy in patients with refractory DMPM, offering a viable salvage treatment option.
- The observed safety profile of apatinib is acceptable, with manageable adverse events, supporting its use in this challenging patient population.
