Safety and efficacy of apatinib combined with iodine-125 in chemotherapy-refractory advanced lung cancer

Abstract

Introduction: Apatinib is a novel anti-angiogenic agent that targets vascular endothelial growth factor receptor-2, and is effective in patients with advanced lung cancer who are refractory to first-line chemotherapy. However, there are limited reports on concurrent apatinib therapy with iodine-125 radioactive seeds brachytherapy in elderly patients with advanced lung cancer. Patient concerns: We describe the first reported case of a 70-year-old woman with advanced lung cancer (T3N3M1, stage IV) who received concurrent apatinib and iodine-125 radioactive seeds brachytherapy after the failure of platinum-based doublet chemotherapy Diagnosis: The patient was diagnosed with left lower lung cancer with mediastinal lymph node metastasis by chest computed tomography. Interventions: Initially, apatinib alone was used as second-line cancer therapy. Subsequently, the patient received concurrent apatinib and iodine-125 radioactive seeds brachytherapy. Outcomes: The patient achieved partial response shortly after undergoing treatment with only apatinib. During the treatment, the tumor continued to respond to apatinib therapy, and the lung metastases were diminished eventually. However, a chest computed tomography scan showed a large cavity in the lung tumor. Thereafter, the patient received concurrent apatinib and iodine-125 radioactive seeds brachytherapy. Unfortunately, she died due to pulmonary infection. Conclusion: Apatinib alone may be a good second-line therapy for advanced lung cancer patients who are refractory to platinum-based doublet chemotherapy. However, its potential benefits, especially as combination therapy, need further investigation by future prospective clinical studies. Elderly patients with advanced lung cancer may benefit from concurrent apatinib with iodine-125 radioactive seeds brachytherapy when chemotherapy is not tolerated or effective. Further studies are needed to investigate the clinical outcomes and toxicities associated with concurrent apatinib and radiation therapy in patients with advanced lung cancer.

A case report of low-dose apatinib in the treatment of advanced triple-negative breast cancer

“…At the same time, it has acceptable toxicity. It also shows that the bioavailability in the human body is relatively high, and it is convenient to take orally in clinical practice, with a certain degree of safety, which is easily tolerated by patients ( 8 ). Here, we report a typical case of TNBC with lung metastasis.…”

Iodine-125 seed inhibits proliferation and promotes apoptosis of cholangiocarcinoma cells by inducing the ROS/p53 axis

“…The radiation source can be directly implanted into tumor tissues, thus exerting a strong killing effect on tumor cells in the treatment target area and causing little damage to surrounding normal tissues (Zakeri et al 2019 ). Iodine-125 seed ( 125 I seed), as the main radioactive particles used in clinical settings in China, are small in size and low in energy (Wu et al 2018 ) and can release large doses of γ-rays into tumor tissues at close ranges, which can inhibit the mitosis of tumor cells and significantly reduce the re-proliferation of tumor tissues, causing no damage to normal tissues with fewer toxic side effects (Zhang et al 2020 ). In the 1970s, 125 I seed brachytherapy was initially employed in prostate cancer (Zaorsky et al 2017 ).…”