Apatinib for salvage treatment of advanced malignant pleural mesothelioma: A case report

Our plain-English summary of Apatinib for salvage treatment of advanced malignant pleural mesothelioma: A case report, by Z. Du, Y. Yu, D. Wu, et al (Medicine, 2018).

The study

• Authors: Z. Du, Y. Yu, D. Wu, G. Zhang, Y. Wang, L. He, R. Meng
• Journal: Medicine
• Published: 2018;97(45):e13105
• Type of article: Case report
• Cited by: 3 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Rationale: Malignant Pleural Mesothelioma (MPM) is rare cancer and has a poor prognosis with resistance to chemotherapy or radiotherapy. Until now there is no standard third-line treatment for patients who have failed second-line therapy.

Patient Concerns: A 58-year-old non-smoking female peasant of ethnic Han was admitted to the oncology department of the 363 Hospital with a primary complaint of chest tightness and breathlessness from 3 months ago.

Diagnoses: Positron emission tomography-computed tomography (PET/CT) examination showed "dirty" pleural and parietal pleural involvement as well as mediastinal and pulmonary hilar lymph node enlargement. Finally, cancer cells were seen after repeated pleural effusion cell examination. Immunohistochemistry confirmed epithelioid of pleural mesothelioma.

Interventions: Apatinib as a third-line treatment after failure from pemetrexed/cisplatin (PC) as the first-line chemotherapy and gemcitabine/cisplatin (GP) as the second-line chemotherapy. At first, 250 mg/day was given and 1 week later, the dose was increased to 500 mg/day.

Outcomes: A 5-month progression-free survival was achieved and toxicity included severe hand-foot syndrome, mild proteinuria, and hypertension.

Lessons: Apatinib may be a potential therapeutic drug for MPM, particularly as a third-line treatment in cases resistant to chemotherapeutic options.

In plain English

This was a case report from the 363 Hospital in Cheng Du, China, about one patient: a 58-year-old non-smoking woman, described as a peasant of Han ethnicity. She was admitted in September 2015 with chest tightness and breathlessness and was diagnosed with epithelioid malignant pleural mesothelioma. The article does not mention asbestos exposure. Her cancer kept growing after first-line pemetrexed and cisplatin (2 cycles) and second-line gemcitabine and cisplatin (1 cycle). From September 2016 she took apatinib, a drug that targets a blood-vessel growth signal, at 250 mg per day, raised to 500 mg per day after one week. After 6 weeks her pleural nodules and a left lung lesion partly shrank, and her blood test results and daily functioning improved. Apatinib was continued for 5 months, until scans showed spread to the liver in February 2017. Side effects included severe hand-foot syndrome, protein in the urine and high blood pressure. She died on March 11, 2017. The authors concluded that apatinib may be a potential salvage treatment for this cancer. They noted that a case report cannot replace randomized trials.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report of a single patient, with a discussion of the literature
• Who was studied: One 58-year-old non-smoking Han Chinese woman, described as a peasant, admitted to the oncology department of the 363 Hospital, Cheng Du, China, in September 2015 with chest tightness and breathlessness. She was diagnosed with epithelioid malignant pleural mesothelioma.
• Exposure: The article reports no asbestos or other occupational exposure for the patient. What the report studied was treatment: apatinib as third-line therapy after first-line pemetrexed/cisplatin and second-line gemcitabine/cisplatin. The starting dose was 250 mg, raised one week later to 500 mg per day.
• Main results:
  • In this patient, a partial response was seen in multiple right pleural nodules and a left lung lesion after 6 weeks of apatinib. Her performance status improved from 3 to 1.
  • In this patient, hemoglobin rose from 65 g/L to 123 g/L and albumin from 29.4 g/L to 40.1 g/L. White blood cell count fell from 14.11 to 5.60 (times 10 to the 9th per litre).
  • Apatinib was continued for 5 months as maintenance therapy. It was stopped in February 2017 when CT showed liver metastasis and the disease was judged to be progressing.
  • Side effects in this patient were severe hand-foot syndrome (grade 3) and mild proteinuria (grade 2). Hypertension (grade 2) appeared in the fifth month and needed an anti-hypertension drug.
  • A fourth-line regimen of gemcitabine and pemetrexed plus apatinib lasted only 1 cycle because of severe toxicity. All treatment was then stopped, and the patient died on March 11, 2017.
  • The authors reported that apatinib gave this patient her longest progression-free period of the three lines of treatment (first-line PFS was 3 months). They reported her overall survival as 18 months.
• The authors' conclusion: The authors concluded that, in this case, apatinib improved the patient's quality of life, PFS and OS. They described it as a potential salvage drug for malignant pleural mesothelioma, especially as third-line treatment, and said further clinical trials are needed.
• Limitations the authors state:
  • A case report cannot replace randomized controlled trials. It cannot show whether apatinib suits all patients with this cancer, or what dose is appropriate.
  • The authors could not obtain pathological tests and immunohistochemistry that would strongly support their use of apatinib.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Lung cancer, Mesothelioma.

Medical terms in this study, explained in our Lexicon: Pleural Mesothelioma, Prognosis, Chemotherapy, Second-Line Therapy, Pleural Effusion, Immunohistochemistry, Epithelioid, Pemetrexed (Alimta).

Related studies

• Low-Dosage Apatinib as Rescuing Treatment in Advanced Malignant Pleural Mesothelioma — Y.Y. Liu, W.Y. Zhang, et al. (2020)
• Successful salvage chemotherapy with gemcitabine and vinorelbine in a malignant pleural mesothelioma patient previously treated with pemetrexed — T. Agatsuma, T. Koizumi, et al. (2010)
• Tremelimumab for patients with chemotherapy-resistant advanced malignant mesothelioma: an open-label, single-arm, phase 2 trial — L. Calabrò, A. Morra, et al. (2013)
• Phase 1 cohort expansion study of LY3023414, a dual PI3K/mTOR inhibitor, in patients with advanced mesothelioma — M.G. Zauderer, E.W. Alley, et al. (2021)
• Salvage therapy with topical antifungal for Aspergillus fumigatus empyema complicating extrapleural pneumonectomy — M. Purohit, A. Guleri, et al. (2012)
• Vinorelbine in pemetrexed-pretreated patients with malignant pleural mesothelioma — P.A. Zucali, M. Perrino, et al. (2014)

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