Catequentinib/pembrolizumab

Abstract

A 73-year-old man exhibited lack of efficacy during treatment with catequentinib and pembrolizumab for metastatic angiosarcoma.The man developed a dry cough in July 2019. Initial investigations were performed and he was treated with unspecified cough medications; these were ineffective. In December 2019, he had dark-red blood in his sputum. He was treated with unspecified traditional Chinese medicines with no significant improvement. Subsequently, he was noted to have pulmonary nodules on 10 January 2020. He was treated with moxifloxacin and linezolid. He was admitted. Investigations were suggestive of vasculitis. Further investigations suggested Mycobacterium chelonae, and he was treated with unspecified antibiotics, posaconazole and methylprednisolone. He had persistent cough and blood sputum. The finding were noted to have worsened further on 17 February 2020. Further differential diagnoses included organised pneumonia and systemic vasculitis treated with unspecified hormonal therapy and methylprednisolone. Upon multidisciplinary discussion, he was diagnosed with Wagner's granuloma on 24 February 2020. He was treated with methylprednisolone, immune globulin [immunoglobulin] and unspecified thymus hormones [thymosin]. His symptoms and findings continued to deteriorate. Eventually, he was diagnosed with metastatic angiosarcoma which was noted to be the cause of haemoptysis and pulmonary nodules. He was treated with catequentinib [anlotinib; route not stated] 12 mg/day. Findings of next generation sequencing revealed no effective targeted drugs. He started receiving IV pembrolizumab 200mg. Initially, his pleural effusion decreased and pulmonary lesions resolved. However, his haemoptysis did not improved, and he developed respiratory failure. The various treatments did not terminate the disease progression. He had gradual development of multiple serosal cavity effusions, liver failure, heart failure and disseminated intravascular coagulation. Eventually, he died less than 1 month following the initial diagnosis.