Case Report
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 16, 2022; 10(11): 3593-3600
Published online Apr 16, 2022. doi: 10.12998/wjcc.v10.i11.3593
Successful apatinib treatment for advanced clear cell renal carcinoma as a first-line palliative treatment: A case report
Hang-Ping Wei, Jie Mao, Zu-Liang Hu
Hang-Ping Wei, Zu-Liang Hu, Department of Medical Oncology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Jie Mao, Department of Radiology, Dongyang Hospital Affiliated to Wenzhou Medical University, Dongyang 322100, Zhejiang Province, China
Author contributions: Hu ZL and Wei HP were medical oncologist of the patients, who consulted the literature and participated in the drafting of the manuscript; Mao J was responsible for the imaging data of patients; all authors have approved the final version of the manuscript to be submitted.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zu-Liang Hu, Doctor, Deputy Director, Department of Medical Oncology, Dongyang Hospital Affiliated to Wenzhou Medical University, No. 60 West Wuning Road, Dongyang 322100, Zhejiang Province, China. applewhp1988@163.com
Received: December 6, 2021
Peer-review started: December 6, 2021
First decision: January 18, 2022
Revised: January 26, 2022
Accepted: February 27, 2022
Article in press: February 27, 2022
Published online: April 16, 2022
Abstract
BACKGROUND

Apatinib is an orally bioavailable small-molecule receptor tyrosine kinase inhibitor. In December 2014, the China Food and Drug Administration made it the first anti-angiogenic therapy to be approved for treating metastatic gastric cancer. It was specifically designated as a third-line or later treatment for metastatic gastric cancer.

CASE SUMMARY

Here, we present a case of advanced renal cell carcinoma (RCC) with multiple metastases (Stage IV) in a 48-year-old male with an extremely poor general status (Karnofsky 30%). He was initially given pazopanib as a targeted therapeutic. However, he experienced severe adverse reactions within two weeks, including grade IV oral mucositis. We, thus, tried switching his targeted treatment to an apatinib dose of 250 mg once daily since April 2018. The patient demonstrated striking benefits from this switch to the apatinib palliative treatment. Nearly one month later, his pain and other associated symptoms were alleviated. The patient was able to move freely and had an excellent general status (Karnofsky 90%). His progress has been followed up with regularly, allowing for a documented progression-free survival interval of approximately 32 mo.

CONCLUSION

This case suggests that, like other multi-target drugs, apatinib may be a useful first-line therapeutic drug for advanced RCC. It may be a particularly helpful curative option when patients are found to be intolerant of other targeted drugs.

Keywords: Apatinib, Renal cell carcinoma, Targeted therapy, Palliative treatment, Case report

Core Tip: Apatinib, an orally bioavailable small-molecule receptor tyrosine kinase inhibitor, is typically used in the treatment of partial solid tumours. Here, we report a case of advanced renal cell carcinoma (RCC) with multiple metastases (Stage IV) in a 48-year-old man with an extremely poor general status (Karnofsky 30%). Due to his intolerance to pazopanib (patient developed oral mucositis), we attempted targeted treatment with apatinib, at a dose of 250 mg once daily (from April 2018). This led to an excellent recovery response, realising an approximately 32 mo progression-free survival. This case suggests that apatinib, like other multi-target drugs, may be used as a first-line therapeutic treatment for advanced RCC.