title: Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma.
abstract: Spindle cell carcinoma of the breast is a rare subtype of metaplastic carcinoma, and no effective chemotherapy special for metaplastic carcinoma exists until now. As spindle cell carcinomas of the breast are typically "Triple Negative", endocrine therapy and molecular therapy targeted to Her2 might not be favorable, resulting in poor prognosis. Apatinib is currently being tested in patients with breast or lung cancers. Here we report a successful case using Apatinib to treat spindle cell carcinoma of breast.A 52- year- old woman presented with a gradually enlarged lump in left breast, which was revealed to be a triple-negative spindle cell carcinoma, underwent a modified radical mastectomy. After the first line chemotherapy with Cyclophosphamide and Epirubicin, multiple metastases in bilateral lung and left anterior thoracic wall appeared. After disease progressed with therapy of Bevacizumab combined with Albumin-bound Paclitaxel and Cisplatin, we treated the patient with Apatinib according to her VEGFR expression, which showed nearly complete response and controllable and tolerated side effects. Next-generation sequencing analysis of the tumor specimen and real time ctDNA was performed to observe the mutated gene numbers matched with therapeutic effect. The present case can help to provide a new and effective therapy strategy to treat advanced spindle cell carcinoma.
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Na
authors.initials: N
authors.lastname: Zhou
authors.affiliation: Department of Oncology, Qingdao Municipal Hospital, Qingdao, China.
authors.forename: Congmin
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Helei
authors.initials: H
authors.lastname: Hou
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Chuantao
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Dong
authors.initials: D
authors.lastname: Liu
authors.affiliation: Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Guanqun
authors.initials: G
authors.lastname: Wang
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Kewei
authors.initials: K
authors.lastname: Liu
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Jingjuan
authors.initials: J
authors.lastname: Zhu
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Hongying
authors.initials: H
authors.lastname: Lv
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Tianjun
authors.initials: T
authors.lastname: Li
authors.affiliation: Department of Oncology, The Affiliated Hospital of Qingdao University, Qingdao, China.
authors.forename: Xiaochun
authors.initials: X
authors.lastname: Zhang
mesh_terms: D000068196:Albumin-Bound Paclitaxel / Q000494:pharmacology / Q000627:therapeutic use; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000494:pharmacology* / Q000627:therapeutic use; D000068258:Bevacizumab / Q000494:pharmacology / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000032:analysis; D001940:Breast / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002277:Carcinoma / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000235:genetics / Q000556:secondary; D017024:Chemotherapy, Adjuvant / Q000379:methods; D000074141:Circulating Tumor DNA / Q000302:isolation & purification; D002945:Cisplatin / Q000494:pharmacology / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000494:pharmacology / Q000627:therapeutic use; D018450:Disease Progression; D019008:Drug Resistance, Neoplasm; D015251:Epirubicin / Q000494:pharmacology / Q000627:therapeutic use; D066246:ErbB Receptors / Q000235:genetics / Q000378:metabolism; D005260:Female; D060831:Hand-Foot Syndrome / Q000209:etiology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D006973:Hypertension / Q000139:chemically induced; D008175:Lung Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000235:genetics / Q000556:secondary; D015411:Mastectomy, Modified Radical; D008875:Middle Aged; D009154:Mutation; D009389:Neovascularization, Pathologic / Q000188:drug therapy; D000072078:Positron Emission Tomography Computed Tomography; D047428:Protein Kinase Inhibitors / Q000627:therapeutic use; D011725:Pyridines / Q000627:therapeutic use*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000235:genetics / Q000378:metabolism; D017422:Sequence Analysis, DNA / Q000379:methods; D013899:Thoracic Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000235:genetics / Q000556:secondary; D017211:Treatment Failure; D064726:Triple Negative Breast Neoplasms / Q000188:drug therapy* / Q000235:genetics / Q000473:pathology / Q000601:surgery
chemical_list: D000068196:Albumin-Bound Paclitaxel; D000970:Antineoplastic Agents; D014408:Biomarkers, Tumor; D000074141:Circulating Tumor DNA; D047428:Protein Kinase Inhibitors; D011725:Pyridines; D000068258:Bevacizumab; D015251:Epirubicin; C553458:apatinib; D003520:Cyclophosphamide; C512478:EGFR protein, human; D066246:ErbB Receptors; D040262:Receptors, Vascular Endothelial Growth Factor; D002945:Cisplatin
keywords: VEGFR; spindle cell carcinoma; targeted therapy; apatinib