A pilot clinical study of apatinib plus irinotecan in patients with recurrent high-grade glioma: Clinical Trial/Experimental Study

Lei Wang, Lijun Liang, Tao Yang, Yun Qiao, Youyou Xia, Liang Liu, Chao Li, Peizhi Lu, Xiaodong Jiang, Lei Wang, Lijun Liang, Tao Yang, Yun Qiao, Youyou Xia, Liang Liu, Chao Li, Peizhi Lu, Xiaodong Jiang

Abstract

Background: Malignant glioma is the most common primary malignant brain tumor that displays high vascularity, making vascular endothelial growth factor receptors become promising targets. This study was conducted to evaluate the efficacy and safety of apatinib, a new potent oral small-molecule tyrosine kinase inhibitor targeted vascular endothelial growth factor receptor 2, combined with irinotecan, in patients with recurrent malignant glioma.

Methods: Ten patients with recurrent malignant glioma who were experiencing relapse after treatment of temozolomide were enrolled in this study. They received oral apatinib (500 mg qd) in conjunction with irinotecan (340 mg/m or 125 mg/m depending on use of enzyme-inducing antiepileptic drugs) for 6 cycles. After that the patients continued to take apatinib as maintenance. Dosage adjustment occurred in only 3 (30.0%) patients.

Results: Among the 10 patients, 9 were available for the efficacy evaluation. There were 5 with partial response, 2 with stable disease and 2 with progressive disease. The objective response rate and the disease control rate (DCR) were 55% (5/9) and 78% (7/9), respectively. The median progress free survival time was 8.3 months. As for safety analysis, the most 3 common adverse events were gastrointestinal reaction (31.8%), hypertension (22.7%), and myelosuppression (18.0%).

Conclusion: Apatinib combined with irinotecan seems to be a promising therapeutic option for recurrent malignant glioma patients. Perspective clinical studies with adequate sample size are required to validate our results.

Trial registration: NCT02848794 /Ahead-BG306.

Conflict of interest statement

The authors have no conflicts of interest to disclose.

Figures

Figure 1
Figure 1
The efficacy evaluation of apatinib in high-grade malignant gliomas patients: PFS curve of apatinib combined with irinotecan therapy. PFS = progress free survival time.
Figure 2
Figure 2
MRI of the patient (no. 1) with glioblastoma: (A) pretreatment MRI scan; (B) posttreatment MRI scan after 3 mo; (C) posttreatment MRI scan after 11 mo; (D) MRI scan of second relapse in April 2016. MRI = magnetic resonance imaging.
Figure 3
Figure 3
MRI of the patient (no. 2) with anaplastic astrocytoma: (A) pretreatment MRI scan; (B) posttreatment MRI scan after 3 mo; (C) posttreatment MRI scan after 4 mo; (D) posttreatment MRI scan after 9 mo. MRI = magnetic resonance imaging.

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