Long-term progression-free survival of apatinib monotherapy for relapsed ovarian cancer: a case report and literature review

Abstract

Ovarian cancer is the deadliest gynecologic malignancy, which poses a great threat to female health. Anti-angiogenic therapy could bring clinical benefit for patients with ovarian cancer. Apatinib, an oral small-molecule vascular endothelial growth factor receptor-2 inhibitor, has shown notable therapeutic effect in a wide variety of tumors. We report a woman with advanced ovarian cancer who received apatinib at 250 mg/day after failure of multiple-line treatment regimens, followed by discussion through review of literature. The patient has quite a long progression-free survival time of 24 months, with a satisfactory quality of life. Apatinib monotherapy may provide an additional option for advanced ovarian cancer，but it still needs further observation and exploration.

Keywords: anti-angiogenic therapy; apatinib monotherapy; ovarian cancer; vascular endothelial growth factor receptor.

Figure 1

Hepatic metastases and incision implantation metastasis before apatinib treatment. Metastatic lesions when the patient first attended our hospital on March 2015 (A1, A2, A3); During the treatment of icotinib, the metastatic mass became bigger (C1, C2, June 2016), compared to two months earlier (B1, B2, April 2016). Red arrows indicate the hepatic metastasis and incision implantation metastasis.

Figure 2

Hepatic metastasis and incision implantation metastasis change during apatinib treatment. Hepatic metastatic mass and incision implantation metastasis lesion before the treatment of apatinib (A1, B1, October 2016) and after two months of apatinib treatment (A2, B2); From March 2017 to August 2018, the metastatic lesions showed no obvious change (A3–A6, B3–B6). Red arrows indicate the hepatic metastasis and incision implantation metastasis.

Figure 3

Timeline of treatment and trend in level of CA 125 and CA 15–3 during treatment. Green color indicates time without treatment. Abbreviations: TC, paclitaxel/carboplatin; GP, gemcitabine/cisplatin; DC/CIK, dendritic cell/cytokine induced killer biological cell immunotherapy; DTX, docetaxel; TP, liposome paclitaxel/lobaplatin; PP, pemetrexed/nedaplatin; IF, irinotecan/capecitabine; SD, stable disease; PD, progressive disease.

Figure 4

Positron emission tomography-computed tomography scan showed that the disease had progressed, metastatic lesions in liver, lung and the pelvic peritoneal had progressed and multiple lymph node metastases (include left lower neck, left superior clavicle, left internal breast area, anterior costal diaphragm angle, abdominal cavity and retroperitoneum) (A–F).