Targeted therapy with anlotinib for patient with recurrent glioblastoma: A case report and literature review

Yajuan Lv, Jiandong Zhang, Fengjun Liu, Meijuan Song, Yong Hou, Ning Liang, Yajuan Lv, Jiandong Zhang, Fengjun Liu, Meijuan Song, Yong Hou, Ning Liang

Abstract

Rationale: Glioblastoma (GBM) is the most aggressive malignant brain tumor in adults. The first choice for GBM is surgery, and followed by a combination of radiotherapy and chemotherapy. There are limited treatments for patients with recurrent GBM. Relapsed patients usually have a worse prognosis, and with a median survival time of <6 months. Anlotinib is a novel small molecule multi-target tyrosine kinase inhibitor that can inhibit tumor angiogenesis and inhibit tumor cell growth. This drug has been used to treat advanced lung cancer.

Patient concerns: We present a case of recurrent GBM was treated with anlotinib in this report. The patient was diagnosed with GBM in August 2016 and treated with surgery and temozolomide (TMZ) chemotherapy. She was diagnosed with recurrence in February 2017 following which she was treated with gamma knife and TMZ chemotherapy. In November 2017, the patient presented with decreased vision in left eye. She was given radiation and her left eye vision returned to normal after radiation. On May23, 2018, the patient reported a decrease in left visual acuity again.

Diagnoses: Brain magnetic resonance imaging (MRI) showed progression of the disease, and the tumor invaded the left optic nerve.

Interventions: This patient was administer anlotinib 12 mg po qd (d1-14, 21days as a cycle). Three cycles anlotinib were given to this patient.

Outcomes: The patient reported her left visual acuity increased over 10 days after first cycle of anlotinib treatment. MRI scan revealed tumor volume shrinks, especially the part that invades the left optic nerve shrinks significantly at 26 days after anlotinib treatment on August 11, 2018. However, the tumor progressed in 2 months after using of anlotinib. From the beginning of the application of anlotinib to death, her survival time was 110 days.

Lessons: Anlotinib treatment with mild side effects may be a new option for the patients with recurrent glioblastoma.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
MRI findings in patient presented with glioblastoma. A and B represent MRI T1 weighting and T2 weighting, respectively. 1, 2, and 3 represent before, 1 month after treatment, and 2 months after treatment of anlotinib, respectively. MRI = magnetic resonance imaging.

References

    1. Stupp R, Mason WP, van den Bent MJ, et al. Radiotherapy plus concomitant and adjuvant temozolomide for glioblastoma. N Engl J Med 2005;352:987–96.
    1. Clarke J, Butowski N, Chang S. Recent advances in therapy for glioblastoma. Arch Neurol 2010;67:279–83.
    1. Olson JJ, Nayak L, Ormond DR, et al. The role of targeted therapies in the management of progressive glioblastoma:a systematic review and evidence-based clinical practice guideline. J Neurooncol 2014;118:557–99.
    1. Xie C, Wan X, Quan H, et al. Preclinical characterization of anlotinib, a highly potent and selective vascular endothelial growth factor receptor-2 inhibitor. Cancer Sci 2018;109:1207–19.
    1. Shen G, Zheng F, Ren D, et al. Anlotinib: a novel multi-targeting tyrosine kinase inhibitor in clinical development. J Hematol Oncol 2018;11:120.
    1. Reardon DA, Turner S, Peters KB, et al. A review of VEGF/VEGFR-targeted therapeutics for recurrent glioblastoma. J Natl Compr Canc Netw 2011;9:414–27.
    1. Louis DN, Ohgaki H, Wiestler OD, et al. The 2007 WHO classification of tumours of the central nervous system. Acta Neuropathol 2007;114:97–109.
    1. Chen Z, Xu N, Zhao C, et al. Bevacizumab combined with chemotherapy vs single-agent therapy in recurrentglioblastoma: evidence from randomized controlled trials. Cancer Manag Res 2018;10:2193–205.
    1. Wong ET, Gautam S, Malchow C, et al. Bevacizumab for recurrent glioblastoma multiforme: a meta-analysis. J Natl Compr Canc Netw 2011;9:403–7.
    1. Gerstner ER, Ye X, Duda DG, et al. A phase I study of cediranib incombination with cilengitide inpatients with recurrent glioblastoma. Neuro Oncol 2015;17:1386–92.
    1. Batchelor TT, Duda DG, di Tomaso E, et al. Phase II study of cediranib, an oral pan-vascular endothelial growth factor receptor tyrosine kinase inhibitor, in patients with recurrent glioblastoma. J Clin Oncol 2010;28:2817–23.
    1. Sorensen AG, Batchelor TT, Zhang WT, et al. A “vascular normalization index” as potential mechanistic biomarker to predictsurvival after a single dose of cediranib in recurrent glioblastoma patients. Cancer Res 2009;69:5296–300.
    1. Tracy T, Batchelor TT, Mulholland P, et al. Phase III randomized trial comparing the efficacy of cediranib as monotherapy, and in combination with lomustine, versus lomustine alone in patients with recurrent glioblastoma. J Clin Oncol 2013;31:3212–8.
    1. Reardon DA, Egorin MJ, Quinn JA, et al. Phase II study of imatinib mesylate plus hydroxyurea in adults with recurrent glioblastoma multiforme. J Clin Oncol 2005;23:9359–68.
    1. Hassler MR, Vedadinejad M, Flechl B, et al. Response to imatinib as a function of target kinase expression in recurrentglioblastoma. Springerplus 2014;3:111.
    1. Reardon DA, Lassman AB, Schiff D, et al. Phase 2 and biomarker study of trebananib, an angiopoietin-blocking peptibody, with and without bevacizumab for patients with recurrent glioblastoma. Cancer 2018;124:1438–48.
    1. Duerinck J, Du Four S, Vandervorst F, et al. Randomized phase II study of axitinib versus physicians best alternative choiceof therapy in patients with recurrent glioblastoma. J Neurooncol 2016;128:147–55.
    1. Chheda MG, Wen PY, Hochberg FH, et al. Vandetanib plus sirolimus in adults with recurrent glioblastoma: results of a phase I and dose expansion cohort study. J Neurooncol 2015;121:627–34.
    1. McNeill K, Iwamoto F, Kreisl T, et al. A randomized phase ii trial of vandetanib (zd6474) in combination with carboplatin versus carboplatin alone in adults with recurrent glioblastoma. Neurooncology 2014;16:v8–22.
    1. Hutterer M, Nowosielski M, Haybaeck F, et al. A single-arm phase II Austrian/German multicenter trial on continuous daily sunitinib in primary glioblastoma at first recurrence (SURGE 01-07). Neuro Oncol 2014;16:92–102.
    1. Pan E, Yu D, Yue B, et al. A prospective phase II single-institution trial of sunitinib for recurrent malignant glioma. J Neurooncol 2012;110:111–8.
    1. Grisanti S, Ferrari VD, Buglione M, et al. Second line treatment of recurrent glioblastoma with sunitinib: results of a phase II study and systematic review of literature. J Neurosurg Sci 2016;Se28.
    1. Iwamoto FM, Lamborn KR, Robins HI, et al. Phase II trial of pazopanib (GW786034), an oral multi-targeted angiogenesis inhibitor, for adults with recurrent glioblastoma (North American Brain Tumor Consortium Study 06-02). Neuro Oncol 2010;12:855–61.
    1. De Groot JF, Wen PY, Lamborn K, et al. Phase II single arm trial of aflibercept in patients with recurrent temozolomide-resistant glioblastoma: NABTC 0601. J Clin Oncol 2008;26:2020.
    1. Lee EQ, Kuhn J, Lamborn KR, et al. Phase I/II study of sorafenib in combination with temsirolimus for recurrentglioblastoma or gliosarcoma: North American Brain Tumor Consortium study 05-02. Neuro Oncol 2012;14:1511–8.
    1. Schiff D, Kurt A, Jaeckle SK, et al. Phase 1/2 trial of temsirolimus and sorafenib in the treatment of patients with recurrent glioblastoma: North Central Cancer Treatment Group Study/Alliance N0572. Cancer 2018;124:1455–63.
    1. Lin B, Song X, Yang D, et al. Anlotinib inhibits angiogenesis via suppressing the activation of VEGFR2 PDGFR and FGFR1 Gene. Gene 2018;654:77–86.

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