Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3593
Peer-review started: December 6, 2021
First decision: January 18, 2022
Revised: January 26, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Processing time: 122 Days and 22.2 Hours
Apatinib is an orally bioavailable small-molecule receptor tyrosine kinase inhibitor. In December 2014, the China Food and Drug Administration made it the first anti-angiogenic therapy to be approved for treating metastatic gastric cancer. It was specifically designated as a third-line or later treatment for metastatic gastric cancer.
Here, we present a case of advanced renal cell carcinoma (RCC) with multiple metastases (Stage IV) in a 48-year-old male with an extremely poor general status (Karnofsky 30%). He was initially given pazopanib as a targeted therapeutic. However, he experienced severe adverse reactions within two weeks, including grade IV oral mucositis. We, thus, tried switching his targeted treatment to an apatinib dose of 250 mg once daily since April 2018. The patient demonstrated striking benefits from this switch to the apatinib palliative treatment. Nearly one month later, his pain and other associated symptoms were alleviated. The patient was able to move freely and had an excellent general status (Karnofsky 90%). His progress has been followed up with regularly, allowing for a documented progression-free survival interval of approximately 32 mo.
This case suggests that, like other multi-target drugs, apatinib may be a useful first-line therapeutic drug for advanced RCC. It may be a particularly helpful curative option when patients are found to be intolerant of other targeted drugs.
Core Tip: Apatinib, an orally bioavailable small-molecule receptor tyrosine kinase inhibitor, is typically used in the treatment of partial solid tumours. Here, we report a case of advanced renal cell carcinoma (RCC) with multiple metastases (Stage IV) in a 48-year-old man with an extremely poor general status (Karnofsky 30%). Due to his intolerance to pazopanib (patient developed oral mucositis), we attempted targeted treatment with apatinib, at a dose of 250 mg once daily (from April 2018). This led to an excellent recovery response, realising an approximately 32 mo progression-free survival. This case suggests that apatinib, like other multi-target drugs, may be used as a first-line therapeutic treatment for advanced RCC.