Study Finds Apatinib Could Treat Recurrent or Unresponsive Mesothelioma

Treatment // February 13, 2019

Mesothelioma cancer is difficult to treat, as it often is not properly diagnosed until the later stages of disease. Mesothelioma also frequently recurs after patients achieve remission, making it even more difficult to treat. As such, research is focused on testing and developing new therapies and treatments. Researchers are continually looking for effective second- and third-line treatment methods for patients with recurrent mesothelioma, or patients whose cancer does not respond to standard, first-line treatments like chemotherapy and radiation.

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Apatinib to Treat Mesothelioma

A case study conducted by doctors at the 363 Hospital in China explored the drug apatinib as a potential second- or third-line treatment for those with recurrent mesothelioma. The 58-year-old female patient who was treated in this case study was diagnosed with epithelioid mesothelioma after experiencing chest tightness and shortness of breath over a period of three months.

Depending on an individual’s case, mesothelioma is often treated with a combination therapy of surgery, chemotherapy and/or radiation therapy. For this patient, a chemotherapy treatment combination of pemetrexed and cisplatin was administered in two rounds and proved to be ineffective as a first-line treatment. Currently, the combination treatment of pemetrexed and cisplatin is considered the standard of care for mesothelioma. The patient’s condition worsened following treatment, and she began experiencing chest pain. Doctors applied palliative radiotherapy to minimize the symptoms.

Gemcitabine, another chemotherapy drug, and cisplatin were then administered. This chemotherapy combination has been used for advanced non-small cell lung cancer and mesothelioma as a second-line treatment, though studies have shown mixed results. In this case, the treatment caused worsening anemia and exhaustion, among other symptoms.

Researchers have struggled to find effective second- and third-line therapies for recurrent or unresponsive mesothelioma. Studies have shown mixed results around the efficacy of chemotherapy and other treatment combinations. After this patient did not respond to either therapy combination, apatinib was administered as a “salvage treatment.” Salvage treatments, which are also known as rescue treatments, are typically utilized when the condition does not respond to standard treatments. Doctors decided to utilize apatinib as a salvage treatment after considering the patient’s pre-existing conditions and conditions that developed as a result of previous treatment.

Apatinib, an oral kinase inhibitor drug, works by stopping new blood vessels from forming in the tissue of tumors. This ultimately works to prevent cancerous cells from multiplying and the tumor from growing. The drug is commonly used in other treatments, such as breast, liver and gastric cancers, but has not been commonly used as a method of treatment for mesothelioma.

Apatinib Shows Promising Results for Mesothelioma

After six weeks of treatment with apatinib, the patient’s condition showed a partial response on pleural nodules on the right lung and a lesion on the left lung. Apatinib was used as a maintenance therapy for five months after initial treatment, and the patient’s lesions and nodules stabilized. Although the patient died just under six months after the third-line treatment was administered due to metastasis to the liver and other toxic complications like hand-foot syndrome and hypertension, physical and chemical indicators such as hemoglobin and albumin showed promise for the patient’s response to treatment.

Survival proved to be significantly longer for the patient, as well, as the condition was controlled and progression-free within five months of treatment. The patient survived 18 months post-diagnosis, which exceeded the overall expected survival of 9 – 17 months. Researchers also noted the duration of treatment with apatinib was longer and more effective than first- and second-line treatments.

Apatinib as a Mesothelioma Treatment

Apatinib shows promise as a second or third-line treatment for mesothelioma, as life expectancy and quality of life were both improved as a result of this treatment. Other drugs, such as immunotherapy drug Opdivo, are also actively being studied as alternative or third-line treatment methods for mesothelioma. Although this patient’s response to treatment showed promise in extending mesothelioma patient life expectancies, further research is required to understand how patients can handle drug toxicity and other side effects and how the cancer may respond.