Efficacy and safety of apatinib in radiation-induced brain injury among head and neck cancer: an open-label, single-arm, phase 2 study.
Int J Radiat Oncol Biol Phys 2022;
113:796-804. [PMID:
35378217 DOI:
10.1016/j.ijrobp.2022.03.027]
[Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/04/2022] [Accepted: 03/23/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND
The treatment of radiation-induced brain injury (RI) caused by radiotherapy for head and neck cancer is challenging. Antiangiogenic therapy is a promising treatment. Apatinib is an oral tyrosine kinase inhibitor (TKI) that selectively inhibits vascular endothelial growth factor receptor (VEGFR) 2. We aimed to assess the efficacy and safety of apatinib in patients with RI.
PATIENTS AND METHODS
In this phase 2, open-label, single-arm, prospective study, we recruited patients aged 35-80 years with prior radiotherapy history for head and neck cancer who had newly diagnosed RI at the Sun Yat-sen Memorial Hospital, China. Apatinib was administered at a dosage of 250 mg once daily orally for 4 weeks. A Simon's mini-max two-stage design was performed. The primary outcome was the proportion of patients with an overall clinical efficacy defined as radiographic response ≥ 25% reduction in baseline brain edema volume on magnetic resonance (MR) fluid attenuated inversion recovery (FLAIR) images at week 4. Secondary endpoints were overall improvement rate of brain necrosis, neurological function, and safety.
RESULTS
We screened 37 patients, 36 of whom were enrolled between October 17, 2019 and August 3, 2020. At the cutoff date, 36 patients were assessed for efficacy and safety (19 to stage 1 and 17 to stage 2). Of the 36 patients evaluated for overall clinical efficacy, 22 patients (61.1%; 95%CI 43.5-76.9%) achieved the primary endpoint at week 4. Among the 31 patients with brain necrosis lesions, 19 patients (61.3%; 95%CI 42.2%-78.2%) showed improvement of brain necrosis. The most common grade 1 to 2 adverse events were hand-foot syndrome, fatigue and hypertension There were no treatment-related grade 4-5 toxicities.
CONCLUSION
Oral apatinib shows promising efficacy and is well-tolerated in patients with RI. Further randomized controlled studies are warranted.
TRIAL REGISTRATION
ClinicalTrials.gov (ID: NCT04152681).
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