Concurrent apatinib and local radiation therapy for advanced gastric cancer: A case report and review of the literature

Abstract

Rationale: Apatinib is a novel anti-angiogenic agent targeting vascular endothelial growth factor receptor-2, which is effective in patients with chemotherapy-refractory gastric cancer. There are no reports of concurrent apatinib with local radiation therapy in elderly patients with advanced gastric cancer. PATIENT CONCERNS AND DIAGNOSES:: we present the first published report of a 70-year-old male patient with advanced gastric cancer who received concurrent apatinib and local radiation therapy after failure of oxaliplatin and S-1 chemotherapy.

Interventions and outcomes: The patient received concurrent apatinib and local radiation therapy and was followed up 7 months after therapy without disease progress, 14 months later indicated extensive metastasis and this patient died of pulmonary infection.

Lessons: Elderly patients with advanced gastric cancer may benefit from concurrent apatinib with local radiation therapy when chemotherapy is not tolerated or successful. Further studies are needed to investigate the clinical outcomes and toxicities associated with concurrent apatinib and radiation therapy in gastric cancer.

Figure 1

Postoperative pathology: (A) hematoxylin and eosin staining indicating moderately differentiated gastric adenocarcinoma (100×). (B) Immunohistochemistry showing the expression of HER2 (+) (100×). (C) Immunohistochemistry showing the expression of VEGF (+) (100×). (D) Immunohistochemistry showing the expression of CD31 (+) (100×). (E) Immunohistochemistry showing the expression of CD105 (+) (100×). HER-2 = human epidermal growth factor receptor 2, VEGF = vascular endothelial growth factor.

Figure 2

PET-CT scans: (A) left supraclavicular metastasis (arrow) before apatinib treatment; (B) left supraclavicular metastasis (arrow) after apatinib treatment; (C) mediastinum metastasis (arrow) before concurrent apatinib and radiotherapy; (D) mediastinum metastasis (arrow) after concurrent apatinib and radiotherapy; (E) abdominal metastasis (arrow) before concurrent apatinib and radiotherapy; (F) abdominal metastasis (arrow) after concurrent apatinib and radiotherapy. PET-CT = positron-emission tomography computed tomography.

Figure 3

Pre- and postoperative imaging: (A) clinical target volume (red) of the left supraclavicular region; (B) clinical target volume (red) of the mediastinum; (C) clinical target volume (red) of the abdominal cavity (A–C) gross tumor volume and planning target volume contours omitted for clarity); (D) gastric endoscopy showing anastomotic stenosis due to gastric cancer with intragastric hemorrhage; (E) PET-CT showing extensive distant metastasis in supraclavicular lymph nodes (arrow), the mediastinum (arrow), and multiple parts of the abdominal cavity (circle and arrow) before concurrent apatinib and radiotherapy; (F) PET-CT showing a partial response in the supraclavicular lymph nodes, mediastinum, and multiple parts of the abdominal cavity after concurrent apatinib and radiotherapy. PET-CT = positron-emission tomography computed tomography.