Clinical efficacy and safety of apatinib as maintenance treatment in patients with advanced esophageal squamous cell carcinoma

ABSTRACT

Background: To investigate the clinical efficacy, safety and prognostic factors of apatinib therapy as maintenance treatment in patients with advanced esophageal squamous cell carcinoma.

Methods: We selected 46 patients with advanced esophageal squamous cell carcinoma treated with radiotherapy and chemotherapy in our hospital from January 2017 to February 2019, all of whom were treated with apatinib. We analyzed the clinical efficacy, adverse reactions and prognostic factors. Meanwhile, the expression of VEGFR-2 and NF-kB was detected by the immunohistochemical SABC method.

Results: The oral treatment of apatinib in the VEGFR-2 and NF-kB positive groups was better than that in the negative groups. The disease control rate was 67.39%. The main adverse reactions were hypertension (60.87%). The degree of adverse reactions was mainly grade 1-2. Cox multivariate regression analysis showed that the degree of adverse reactions and ECOG score were independent factors affecting OS in patients with advanced esophageal squamous cell carcinoma.

Conclusion: The positive expression of VEGFR-2 and NF-kB is expected to be the molecular target of oral apatinib targeted therapy for esophageal cancer. Apatinib has a certain clinical effect as the maintenance treatment for advanced esophageal squamous cell carcinoma patients, with mild adverse reactions and high safety.

KEYWORDS:

• Esophageal cancer
• VEGFR-2
• apatinib
• MVD
• adverse reactions

Article highlights

• Radiotherapy and chemotherapy are the main treatments for advanced oesophageal cancer or postoperative recurrence and metastasis. For patients with advanced oesophageal cancer, due to the poor effect of radiotherapy and chemotherapy, targeted therapy has become the research direction for the treatment of advanced oesophageal cancer.

• Molecular targeted therapy has the advantages of strong specificity and few side effects and has become an effective method for the treatment of advanced oesophageal cancer.

• Apatinib is a small molecule tyrosine kinase inhibitor that selectively inhibits vascular endothelial growth factor receptor 2(VEGFR-2) activity.

• Studies have shown that the overexpression rate of VEGF in oesophageal squamous cell carcinoma is 24% −74%.

• The activated NF-kB plays an important role in the survival and proliferation of oesophageal squamous cell carcinoma cells.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer has declared grants from Ono Pharmaceutical, MSD K.K, Mediscience, Merck Biopharma, Astellas, Taiho and Daiichi Sankyo. Peer reviewers on this manuscript have no other relevant financial or other relationships to disclose.

Author contributions

G-H. Liu and Y-B. Wang participated in drafted and finalized the manuscript and revised it critically for intellectual content. C-B. Wang and Y-L. He participated in acquisition, analysis, and interpretation of data for the work. M-Y. E responsible for the guidance and proofreading of the paper.

All authors agree to be accountable for all aspects of the work and all authors read and approved the final manuscript.

Additional information

Funding

The work was funded by The Haiyan Research Fund Youth Project of Harbin Medical University Cancer Hospital [Grant No. JJQN2019-14].