Low dose of apatinib in treating chemotherapy and EGFR-TKI refractory non-small cell lung cancer: A case report

RATIONALE: Lung cancer is the leading cause of cancer-associated deaths all over the world. Although the prognosis of lung cancer has improved over the past decade due to progression in surgical techniques and systematic treatments, the patients with advanced disease still suffer poor survival. There are no standard treatment strategies for patients who have failed to respond to at least 2 lines of chemotherapy in non-small cell lung cancer (NSCLC). Apatinib, one of the latest small-molecule oral anti-angiogenesis targeted agents developed first in China, has shown remarkable anti-tumor efficacy in a variety of solid tumor types. PATIENT CONCERNS: A 72-year-old woman underwent radical resection of the left lung cancer in July 2011, but was found a recurrence of cancer after 2 years. DIAGNOSES: The histopathological examination of the resected specimen identified the lesion as lung adenocarcinoma. INTERVENTIONS: She received gemcitabine and carboplatin regimen as adjuvant chemotherapy for 4 cycles following the surgery in August 2011. After the tumor relapsed, she received multiple lines of chemotherapy including paclitaxel, cisplatin, docetaxel, and gemcitabine from July 2013, but still suffered progressive disease in February 2017. Then apatinib alone was used to defend against the tumor at a dose of 250 mg/d orally till December 2017. OUTCOMES: The efficacy was assessed as partial response 1 month later in March 2017. And the use of apatinib was continued till the patient died of tumor progression, achieving a progression-free survival for 10 months. During the treatment with apatinib, the patient experienced hypertension of grade 1, which was well-tolerated and manageable. LESSONS: Apatinib might be efficient and well-tolerated for patients with advanced NSCLC who have failed to respond to multi-line treatments, even at a low dose.