Efficacy And Feasibility Of Apatinib Mesylate As Neoadjuvant Therapy In Advanced Thyroid Cancer

Objective:This series of studies aims to analyze the clinical efficacy and safety of apatinib mesylate in the treatment of advanced refractory thyroid cancer,and to study the feasibility and efficacy of apatinib as neoadjuvant therapy in advanced thyroid cancer.Methods:Data of 33 patients with advanced refractory thyroid cancer who were treated with apatinib in Henan Cancer Hospital from November 2016 to November 2019 were retrospectively analyzed for clinical efficacy evaluation.In the second study,the data of 3 patients with advanced thyroid cancer who were treated with apatinib before surgery in our hospital were analyzed.Their response to neoadjuvant apatinib treatment was observed to analyze the efficacy and feasibility of apatinib in advanced thyroid cancer.Results:Among 33 study subjects,the median follow-up time were 17(range:4-36)months,the median PFS and the median OS were not achieved.The efficacy of treatment may be summarized as follows:complete response(CR)0/33(0%),partial response(PR)14/33(42.42%),stable disease(SD)12/33(36.36%),progressive disease(PD)7/33(21.21%),DCR is 14/33(42.4%),and ORR 26/33(78.8%),respectively.The adverse effects were hand-foot syndrome(27.27%),hypertension(45.45%),gastrointestinal toxicity(27.27%),fatigue(6.06%),proteinuria(15.15%),leukopenia(6.06%),gingival bleeding(3.03%)and hypocalcemia(15.15%).The second study included 3 patients with advanced thyroid cancer.Radical resection of the tumor was difficult during the first medical treatment.Therefore,the targeted drug apatinib mesylate was administrated before surgery.After neoadjuvant targeted therapy,the tumor size of both patients decreased significantly,and the tumor size of one patient increased slightly.After surgery,two patients continued to receive apatinib after surgery,and the other patient did not continue taking this drug because of no response to apatinib.Follow-up of two patients showed no signs of recurrence,and one patient progressed.Conclusion:The data show that Apatinib may be safely and effectively used in thyroid cancer patients given the fact that its adverse effects were manageable.As neoadjuvant treatment,apatinib is a new treatment strategy for patients with advanced thyroid cancer,which may reduce the size of the tumor,the degree of tumor invasion,and the risk of residual disease after surgical resection,making the unresectable thyroid Cancer become resectable,reducing surgical trauma and risk,thereby improving patients’ quality of life and prognosis.However,further research is needed to solve the problems of timing and interval time of apatinib administration.