Remarkable Response of Metastatic Gallbladder Carcinoma to Apatinib After Failed Multiline Chemotherapies: A Case Report and Literature Review

Abstract

Gallbladder carcinoma (GBC) is a relatively rare and aggressive malignant tumor with a poor prognosis. A systematic review of current clinical studies illustrates an extreme paucity of second-line therapeutic options following the failure of standard-of-care cisplatin-gemcitabine chemotherapy. The efficacy of apatinib, an highly potent and selective oral inhibitor of VEGFR-2 tyrosine kinase, for refractory advanced GBC has not yet been clarified. Herein, we report a case of advanced GBC that presented a durable partial response to apatinib used as monotherapy after the failure of multiline chemotherapies including S-1 monotherapy, capecitabine monotherapy, gemcitabine plus capecitabine, and irinotecan plus oxaliplatin. The patient achieved an efficacy of partial response within 2 months. By September 23, 2019, the duration of treatment had extended for almost 1 year with a satisfactory quality of life, and the administration of apatinib was continued. Dose reduction of apatinib occurred at week four due to grade 2 hypertension and hand-foot skin reaction (HFSR). No fatigue, proteinuria, mucositis, or thrombocytopenia occurred. To the best of our knowledge, this is the first case of a successful use of apatinib monotherapy for heavily pretreated GBC. Further prospective studies are warranted to confirm the efficacy and safety of apatinib in GBC.

Apatinib as non-first-line treatment in patients with Intrahepatic Cholangiocarcinoma

“…For molecular targeted therapy as second-line therapy, only ivosidenib (a small-molecule targeted inhibitor of IDH1) significantly improved median PFS compared with placebo (2.7 months vs 1.4 months, hazard ratio 0.37, one-sided p<0.0001) in patients with previously treated IDH1-mutant cholangiocarcinoma [21]. Notably, various retrospective analyses and clinical case reports suggest apatinib has promising activity and manageable toxicity for the pretreated patients with advanced biliary tract cancers, with ORR around 15% and median PFS around 3.0 months [19,[22][23][24]. In this study, apatinib monotherapy preliminarily showed an underlying anti-tumor activity in patients with advanced CCA, which confirmed the potential therapeutic value of anti-angiogenesis strategy and encouraged further exploration of anti-angiogenesis drugs in chemotherapy refractory CCA.…”