Abstract 1245P
Background
Dual blockade of both EGFR and VEGFR pathways in EGFR-mutant NSCLC has shown enhanced antitumor efficacy versus EGFR-TKIs alone. Apatinib is an orally effective VEGFR-2 tyrosine kinase inhibitor (TKI). Previous studies have shown that apatinib (a TKI against VEGFR-2) combined with EGFR-TKI might prevent progression of the disease. This study aims to evaluate the efficacy and safety of apatinib plus EGFR-TKIs compared with chemotherapy for EGFR-TKI resistant NSCLC patients.
Methods
From Mar 2017 to Nov 2019, this study enrolled 42 advanced NSCLC patients who acquired resistance to the EGFR-TKI therapy. 27 patients received apatinib plus EGFR-TKI (apatinib in start dose of 250 mg plus original EGFR-TKI dose); 15 patients received chemotherapy (pemetrexed or vinorelbine with platinum).
Results
In the apatinib group, 24/27 patients were available to be evaluated. The objective response rate (ORR, % (95%CI)) was 20.83% (7.13%-42.15%) and the disease control rate [DCR, % (95%CI)] was 95.83% (78.88%-99.89%). The most common adverse events in the apatinib group were gastrointestinal reaction (70.37%, 19/27), diarrhea (62.92%, 17/27), hypertension (62.97%, 17/27) and palmar-plantar erythrodysesthesia (40.74%, 11/27). The most common grade 3 or 4 toxicity was proteinuria (11.11%, 3/27). Most adverse events were grade 1 or 2, as well as controllable and tolerable. Six patients with brain metastases in the apatinib group got long median progression-free survival (PFS) of 15.66 months. In the chemotherapy group, 12/15 patients were available to be evaluated. The ORR was 25.00% (5.49%-57.19%) and the DCR was 91.67% (61.52%-99.79%). The most common adverse events were gastrointestinal reaction (80.00%, 12/15) and vomiting (46.67%, 7/15). The median PFS of the apatinib group was 12.55 months, and the chemotherapy group was 3.78 months. The longest PFS in the apatinib group was 35.93 months.
Conclusions
Apatinib plus EGFR-TKI shown a good clinical efficacy in patients with acquired EGFR-TKI resistance. Patient's quality of life and the compliance with therapy had been increased by oral drugs. In addition, we found that patients’ PFS tended to be prolonged in those with EGFR 21 mutation (15.70 months), or were male (17.13 months).
Clinical trial identification
ChiCTR-OIN-17012051.
Editorial acknowledgement
Legal entity responsible for the study
The author.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.