The Efficacy and Safety of Apatinib and Anlotinib in Advanced Non-Small Cell Lung Cancer

Abstract

Background

Anlotinib and apatinib, both vascular endothelial growth factor receptor-tyrosine kinase inhibitors (VEGFR-TKIs), are clinically established in the treatment of advanced non-small cell lung cancer (NSCLC) in China, with anlotinib emerging as a standard treatment strategy. This study was conducted to evaluate the efficacy and safety of apatinib and anlotinib, and to compare their differences in treating patients with advanced NSCLC.

Patients and Methods

We retrospectively analyzed the data of patients with advanced NSCLC treated with apatinib or anlotinib at a hospital in Eastern China from January 2017 to December 2021. The primary endpoint was progression-free survival (PFS), while secondary endpoints included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and safety profile.

Results

A total of 145 patients were included in this study. Median PFS (mPFS) was 3.53 months for the apatinib group and 5.3 months for the anlotinib group (HR = 0.59, 95% CI: 0.41–0.84; P = 0.004), and median OS (mOS) was 7.6 months versus 15.6 months (HR = 0.68, 95% CI: 0.46–1.00; P = 0.048), which all showed significant differences after adjusting for confounders (P < 0.05). Subgroup analysis revealed that the presence or absence of bone metastases significantly influenced PFS in both treatment groups. The ORR was 3.03% in the anlotinib group versus 10.13% in the apatinib group (P = 0.12), the DCR was 72.73% versus 51.90% (P = 0.21). No unanticipated adverse events (AEs) were observed. The incidence of grade 3–4 AEs was significantly higher in the apatinib group (31.65% vs 13.64%, P < 0.05).

Conclusion

Anlotinib demonstrated greater efficacy and safety compared to apatinib in the treatment of advanced NSCLC, particularly in patients with bone metastases and EGFR(-).

Keywords:

• non-small cell lung cancer
• anti-angiogenic drug
• VEGFR-TKIs
• real-world research
• bone metastases

Abbreviations

NSCLC, non-small cell lung cancer; AEs, adverse effects; TKIs, tyrosine kinase inhibitors; VEGFR-TKIs, vascular endothelial growth factor receptor-tyrosine kinase inhibitors; PFS, progression-free survival; mPFS, median progression-free survival; OS, overall survival; CR, complete response; PR, partial response; SD, stable disease; PD, disease progression; ORR, objective response rate; DCR, disease control rate; EGFR, epidermal growth factor receptor; ECOG, Eastern Cooperative Oncology Group; PS, Performance Status; RECIST, Response Evaluation Criteria in Solid Tumors; ICIs, Immune checkpoint inhibitors.

Acknowledgments

The authors extend their gratitude to the participating patients and their families for their invaluable contribution to this study. We also wish to express our appreciation to Professor Xuyao Zhang for his expert assistance in medical writing and to Qigang Dai, a statistician, for his meticulous statistical analysis.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This research was generously supported by the Jiangsu Pharmaceutical Association-Aosaikang Hospital Pharmacy (A202034) and Hengrui Hospital Pharmacy (H202318) Funds, alongside the Pharmacy Research Fund Project from the Bethune Charitable Foundation (Z04JKM2023E040), the Translational Medicine Foundation from the Jiangsu Society of Research Hospital (JY202205), and the Yancheng Medical Science and Technology Development Program Project (YK2019016).