Apatinib in Patients with Relapsed or Refractory Diffuse Large B Cell Lymphoma: A Phase II, Open-Label, Single-Arm, Prospective Study

Xinran Ma, Ling Li, Lei Zhang, Xiaorui Fu, Xin Li, Xinhua Wang, Jingjing Wu, Zhenchang Sun, Xudong Zhang, Xiaoyan Feng, Yu Chang, Zhiyuan Zhou, Feifei Nan, Jieming Zhang, Zhaoming Li, Mingzhi Zhang, Xinran Ma, Ling Li, Lei Zhang, Xiaorui Fu, Xin Li, Xinhua Wang, Jingjing Wu, Zhenchang Sun, Xudong Zhang, Xiaoyan Feng, Yu Chang, Zhiyuan Zhou, Feifei Nan, Jieming Zhang, Zhaoming Li, Mingzhi Zhang

Abstract

Purpose: Treatment options for relapsed or refractory diffuse large B-cell lymphoma (RR DLBCL) represent an unmet medical need. Apatinib is a new oral tyrosine kinase inhibitor mainly targeting vascular endothelial growth factor receptor-2 (VEGFR-2) to inhibit tumour angiogenesis. In the present study, we evaluated the efficacy and safety of apatinib for patients with RR DLBCL.

Patients and methods: In this phase II, open-label, single-arm, prospective study, we enrolled patients aged 14-70 years with treatment failure of at least two chemotherapeutic regimens using Simon's two-stage design. All patients were administered apatinib at an initial dose of 500 mg on a 4-week cycle at home and visited the outpatient clinic every two cycles to evaluate efficacy and to record adverse events. We considered objective response rate (ORR) as the primary end point, and progression-free survival (PFS), and overall survival (OS) plus duration of response (DoR) as the secondary end point. (This trial was registered at ClinicalTrials.gov, identifier: NCT03376958.).

Results: From January 2017 to February 2019, we screened 35 patients and enrolled 32 eligible patients. At the cutoff point (April 2019), we noted 2 (6.3%) complete responses, 12 (37.5%) partial responses, and 9 (28.1%) stable diseases, attributing to an ORR of 43.8% and a disease control rate of 71.9%. The median PFS and OS were 6.9 (95% confidence interval [CI], 5.8-7.9) and 7.9 months (95% CI, 7.0-8.7), respectively. The median DoR was 5.0 months (95% CI, 3.5-6.5) for patients who achieved PR. The most common grade 3-4 adverse events (AE) were hypertension (12.6%), hand-foot syndrome (9.4%), and leucopenia (6.3%). No apatinib-related deaths were noted.

Conclusion: Home administration of apatinib shows promising efficacy and manageable AEs in patients with RR DLBCL.

Keywords: VEGFR-2; apatinib; efficacy; relapsed or refractory diffuse large B-cell lymphoma; safety.

Conflict of interest statement

The authors report no conflicts of interest in this work.

© 2020 Ma et al.

Figures

Figure 1
Figure 1
Trial protocol.
Figure 2
Figure 2
Kaplan–Meier estimates of progression-free survival (PFS) and overall survival (OS).
Figure 3
Figure 3
Waterfall plot of best percentage changes from baseline. Waterfall plot of the best percentage changes from baseline of target tumor size is shown for each patient. Dashed line at −50% represents the threshold of partial response, and another dashed line at 50% represents the threshold of progressive disease. One patient had tumor shrinkage despite of progressive disease. One patient had no tumor size change from baseline.

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