Combination therapy of apatinib with icotinib for primary acquired icotinib resistance in patients with advanced pulmonary adenocarcinoma with EGFR mutation

Abstract

Multi-targeted agents represent the next generation of targeted therapies for solid tumors, and patients with acquired resistance to EGFR-tyrosine kinase inhibitors (TKIs) may also benefit from their combination with TKI therapy. Third-generation targeted drugs, such as osimertinib, are very expensive, thus a more economical solution is required. The aim of this study was to explore the use of apatinib combined with icotinib therapy for primary acquired resistance to icotinib in three patients with advanced pulmonary adenocarcinoma with EGFR mutations. We achieved favorable oncologic outcomes in all three patients, with progression-free survival of four to six months. Unfortunately, the patients ultimately had to cease combination therapy because of intolerable adverse effects of hand and foot syndrome and oral ulcers. Combination therapy of apatinib with icotinib for primary acquired resistance to icotinib may be an option for patients with advanced pulmonary adenocarcinoma with EGFR mutations, but physicians must also be aware of the side effects caused by such therapy.

Keywords: Acquired resistance; advanced pulmonary adenocarcinoma; apatinib; icotinib; molecular targeted therapy.

Figure 1

The time course of the carcinoembryonic antigen (CEA) concentrations measured in patients (a) I and (b) III.

Figure 2

One of three patients developed grade 2–3 hand‐foot syndrome.

Figure 3

Computed tomographic images from patients I, II, and III show the mass(a,c,e) before apatinib treatment, and (b,d,f) after three months of apatinib therapy, respectively.