Basket studies are attempting to evaluate whether a certain biomarker signature is predictive of response to a targeted drug regardless of the tumor of origin. Apatinib,a specific TKI targeting VEGFR-2, shows anti-angiogenesis effects in multiple solid tumors. In addition to hypertension and hand-foot-skin reaction, tumor cavitation and temporary increase in CEA are frequently noted during therapy. This study was to evaluate the frequency and clinical outcome of solid tumor patients who showed cavitation in lung lesions and increase in CEA following apatinib treatment.
This was a retrospective analysis of solid tumor patients treated with apatinib in the Affiliated Hospital of Qingdao University between 2/1/2015 and 7/11/2017. Clinical data were retrieved from medical records, and chest imaging findings were documented. Survival data were analyzed with Kaplan-Meier estimates and compared with log-rank test.
Totally, 103 patients including 71 primary lung cancer patients and 32 patients with lung metastasis were included. During apatinib treatment, 27/71 (38.0%) primary lung cancer patients developed cavitation. Among the metastases cases, tumor cavitation occurred in 15/32 (46.9%) patients. No significant difference was observed between patients with and without cavity formation in age, gender, tumor histology, tumor stage and type of lung lesions (primary or metastasis). Cavity formation was accompanied with the temporary increase in CEA value (76.2% vs. 47.5% in patients with and without cavitary; P=0.0036). The progression-free survival (PFS) of patients with cavitary was 12.71 (95% CI, 11.28-15.47) months, which was significantly longer compared with those without (6.34 [95% CI, 6.07-7.13] months; P<0.0001). Besides, patients with an increase in CEA had a notably longer PFS than those without (12.15 [95% CI, 10.12-15.46] vs. 7.00 [95% CI, 6.14-11.28] months; P=0.0306).
Cavitation formation induced by apatinib is common in patients with multiple solid tumors. Cavitation and CEA increase might have significant effects on PFS prognosis.