Ge Jingjing, Li Cheng, Xue Fengjun, Qi Shaopei, Gao Zhimeng, Yu Chunjiang, Zhang Junping
Department of Neuro-Oncology, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China.
Front Oncol. 2021 Feb 4;10:601175. doi: 10.3389/fonc.2020.601175. eCollection 2020.
Treatment for recurrent glioblastoma is poor, and there is a need for better therapies. Here we retrospectively assessed the efficacy and toxicity of temozolomide plus apatinib, an oral small-molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor 2 in recurrent glioblastoma.
A retrospective analysis of patients with recurrent glioblastoma who underwent apatinib plus temozolomide treatment was performed. Apatinib was given at 500 mg once daily. Temozolomide was administered at 200 mg/m/d on days 1-5 or 50 mg/m/d continuous daily according to whether they had experienced temozolomide maintenance treatment before. The main clinical data collected included tumor characteristics, status of MGMT promoter, and IDH mutation, number of relapse, response, survival, adverse reactions, and salvage therapies.
From April 2016 to August 2019, thirty-one patients were identified. The objective response rate was 26.3%, and the disease control rate was 84.2%. The progression-free survival (PFS) at 6 months and overall survival (OS) at 12 months were 44.6 and 30.2%. The median PFS and OS were 4.9 and 8.2 months, respectively. Two patients achieved long PFS of 30.9 and 38.7+ months. The median survival time after progression of the patients with or without salvage bevacizumab was 5.1 1.2 months. The most common grade 3 or 4 toxicities were hypertension (5.8%), decreased appetite (5.8%), and thrombocytopenia (4.3%), most of which were resolved after symptomatic treatment or dose reduction.
Apatinib plus temozolomide is an effective salvage regimen with manageable toxicities for recurrent glioblastoma and could not reduce the sensitivity to bevacizumab.
复发性胶质母细胞瘤的治疗效果不佳，需要更好的治疗方法。在此，我们回顾性评估了替莫唑胺联合阿帕替尼（一种口服小分子酪氨酸激酶抑制剂，靶向血管内皮生长因子受体2）治疗复发性胶质母细胞瘤的疗效和毒性。
对接受阿帕替尼联合替莫唑胺治疗的复发性胶质母细胞瘤患者进行回顾性分析。阿帕替尼的给药剂量为每日500毫克。替莫唑胺根据患者之前是否接受过替莫唑胺维持治疗，在第1 - 5天按200毫克/平方米/天给药，或持续每日按50毫克/平方米/天给药。收集的主要临床数据包括肿瘤特征、MGMT启动子状态、异柠檬酸脱氢酶（IDH）突变、复发次数、反应、生存情况、不良反应和挽救治疗。
2016年4月至2019年8月，共纳入31例患者。客观缓解率为26.3%，疾病控制率为84.2%。6个月时的无进展生存期（PFS）和12个月时的总生存期（OS）分别为44.6%和30.2%。PFS和OS的中位数分别为4.9个月和8.2个月。两名患者实现了30.9个月和38.7 +个月的长PFS。接受或未接受挽救性贝伐单抗治疗的患者进展后的中位生存时间为5.1±1.2个月。最常见的3级或4级毒性反应为高血压（5.8%）、食欲减退（5.8%）和血小板减少（4.3%），大多数经对症治疗或减量后缓解。
阿帕替尼联合替莫唑胺是一种有效的挽救方案，用于复发性胶质母细胞瘤时毒性可控，且不会降低对贝伐单抗的敏感性。
