Combined use of apatinib mesylate  and vinorelbine versus  vinorelbine alone in recurrent or metastatic  triple-negative breast cancer: study protocol for a randomized controlled clinical trial

Abstract

Background: The emergence of new molecular targeted drugs provides new prospects for the treatment of advanced breast cancer; the future therapeutic trend includes chemotherapy combined with molecular targeted therapy. Apatinib mesylate, a novel, small anti-angiogenic agent, highly selectively inhibits the activity of vascular endothelial growth factor receptor-2 tyrosine kinase. Apatinib mesylate also blocks the signaling of vascular endothelial growth factor binding to its receptor, thereby strongly inhibiting tumor angiogenesis and exerting an anti-tumor effect. However, a randomized controlled clinical trial of apatinib combined with vinorelbine for triple-negative breast cancer (TNBC) has not been reported. We will compare the therapeutic effect of vinorelbine alone, or in combination with apatinib mesylate, in patients with recurrent or metastatic TNBC in North China who have received at least two drug treatments, including anthracyclines and taxanes. Methods/analysis: This study is a triple-blind, randomized, placebo-controlled, parallel-group clinical trial. We plan to include 210 female patients with locally recurrent or metastatic TNBC, admitted at the Liaoning Cancer Hospital & Institute, Northeast China. All enrolled patients will be randomized to oral vinorelbine alone (40 mg, thrice a week [Mondays, Wednesdays, and Fridays] in each 3-week cycle), or in combination with oral apatinib mesylate (500 mg, once daily in each 3-week cycle). Radiographic assessment will be performed every 6 weeks for 36 weeks, and every 9 weeks thereafter. The primary outcome is progression-free survival, and secondary outcomes include overall survival, disease control rate, objective response rate, and incidence of adverse events at grades 3 and 4, as defined by the National Cancer Institute Common Toxicity Criteria Version 4.0. Outcome measures will be evaluated at baseline (< 2 weeks before starting treatment), every 6 weeks during treatment, and at 4 weeks and every 3 months after treatment discontinuation. Discussion: Based on the data from this trial, we hope to identify a treatment plan that is suitable for female TNBC patients in Northeast China who have been treated with anthracyclines and taxanes. Trial registration: ClinicalTrials.gov (identifier: NCT03932526). Registered on April 30, 2019.

Targeted Therapy Breakthrough: Apatinib Enhances Neoadjuvant Chemotherapy in Triple- Negative Breast Cancer

“…Apatinib [14,15] is a potent inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2), which exerts anticancer effects by inhibiting the binding of vascular endothelial growth factor (VEGF) to its receptor (VEGFR), thereby inhibiting tumor angiogenesis and ultimately leading to tumor cell proliferation inhibition due to the resultant tumor hypoxia. Studies have shown that TNBC patients exhibit signi cant VEGF expression, con rming that VEGFR is an effective therapeutic target.…”

Ultrasound-Targeted Microbubble Destruction Enhances Inhibitory Effect of Apatinib on Angiogenesis in Triple Negative Breast Carcinoma Xenografts

“…Apatinib (APA) is an oral small-molecule antiangiogenic drug and can selectively inhibit the tyrosine kinase activity of intracellular VEGFR2 and suppress the interaction between VEGF and VEGFR, exerting an antiangiogenic effect. Clinically, APA is mainly used as the third line treatment of advanced gastric cancer and gastroesophageal junction adenocarcinoma, and the efficacy and adverse reactions of APA in the treatment of TNBC are still being investigated in clinical trials [11][12][13].…”