Multicenter phase II study of apatinib in non-triple-negative metastatic breast cancer.
BACKGROUND
Apatinib is a tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor 2(VEGFR-2). This study was conducted to assess the efficacy and safety of apatinib in patients with non-triple-negative metastatic breast cancer who had received prior chemotherapy for their metastatic disease.


METHODS
This multicenter, open-label, single arm study enrolled patients with non-triple-negative breast cancer, pretreated with anthracycline, taxanes and capecitabine, and who failed in the metastatic setting at least 1 and at most 4 prior chemotherapy regimens and at least one endocrine drug for hormone receptor-positive patients as well as at least one anti-Her2 drug for Her2-positive patients. The primary end point of this study was progression free survival (PFS). Secondary end points included objective response rate (ORR), disease control rate (DCR), overall survival (OS), and toxicity. Apatinib was administered as 500 mg daily on days 1 through 28 of each 4-week cycle.


RESULTS
38 patients were enrolled with a median age of 49 years (range, 35 to 62 years) and received apatinib for a median of 4 cycles (range from 0 to 10 cycles). 18 (47.4%) patients experienced dose reduction during treatment. The median relative dose intensity (relative to assigned dose for each cycle) was 82% (range, 45.0% to 100.0%). Median follow-up time was 10.1 months. Median PFS of all 38 patients was 4.0 months (95% confidence interval (CI), 2.8 m - 5.2 m). 36 patients were eligible for efficacy analysis. ORR was 16.7% (6/36). DCR was 66.7% (24/36). Median OS was 10.3 months (95% CI, 9.1 m - 11.6 m). The most common grade 3/4 treatment-related AEs were hypertension (20.5%), hand-foot syndrome (10.3%), and proteinuria (5.1%). Of three possibly drug-related SAEs recorded in the study, 2 (3.4%) deaths occurred within 28 days of last treatment and were both considered to be the result of disease progression. The other one was grade 2 diarrhea needing hospitalization.


CONCLUSIONS
Apatinib exhibited objective efficacy in heavily pretreated, metastatic non-triple-negative breast cancer with manageable toxicity, and it might be better to be tested in breast cancer with high angiogenesis dependency.


BACKGROUND
ClinicalTrials.gov: NCT01653561.
Department of Medical Oncology, Fudan University Cancer Hospital, Shanghai Medical School, Shanghai, China. huxicun@gmail.com.
Xichun
X
Hu
Jun
J
Cao
Wenwei
W
Hu
Changping
C
Wu
Yueyin
Y
Pan
Li
L
Cai
Zhongsheng
Z
Tong
Shusen
S
Wang
Jin
J
Li
Zhonghua
Z
Wang
Biyun
B
Wang
Xiaoyu
X
Chen
Hao
H
Yu
D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D018572:Disease-Free Survival; D005260:Female; D060831:Hand-Foot Syndrome / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008875:Middle Aged; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011507:Proteinuria / Q000139:chemically induced; D011725:Pyridines / Q000009:adverse effects / Q000627:therapeutic use*; D019233:Retreatment; D015996:Survival Rate; D016896:Treatment Outcome; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy* / Q000473:pathology
D000970:Antineoplastic Agents; D047428:Protein Kinase Inhibitors; D011725:Pyridines; C553458:apatinib