Efficacy
tumor, SD, pain, PD, rupture
TUMOR, LIVER METASTASES, ENLARGEMENT, DISEASE, MINOR
Of 16 patients, three (19%) achieved PR and 13 (81%) achieved SD, with best ORR of 19% and DCR of 100%, respectively. The median time to best ORR was 3.4 months (range:0.2–6.5 months). Among the 13 patients with SD, 12 (92.3%) showed tumor shrinkage (3–28%) and one (7.7%) showed minor tumor enlargement (2%) (Table Effectiveness of 16 patients receiving combination therapy of ATRA and apatinib.Doctor adviceProgression of liver metastases, interventional therapy is recommended to control liver lesionsDoctor adviceThe local lesion progressed. Considering the lesion was close to the skin and may rupture, antiangiogenic targeted therapy was not suitable to use, chemotherapy was recommended but the patient refused.Self‐discontinuationPatient was unwilling to continue treatment and failed to use other treatmentATRA intolerancePhysician suggested change drugs, but patients wanted to continue with apatinib and stop ATRA——(The lesion progressed slowly, recommended to switch to use other targeted drugs. Patient want to continue use the drug, considering convenient and tolerable of current regimen)Doctor adviceProgressed in lung. Physician suggested switching to other targeted drugs, but refused by patient.Self‐discontinuationPatient thought that the drug was ineffective, so selected surgical treatment although physician did not recommend surgery because of the multiple lesions in lungSelf‐discontinuationPatient refused to continue current treatment and other treatments after progression.Doctor adviceProgression in lung, other targeted drugs were recommended.Doctor adviceAggravation of local pain, chemotherapy was recommended.Doctor adviceRapid progression in lung, chemotherapy was recommended.Doctor adviceProgression in lung, other targeted drugs were recommended.Doctor adviceRapid lung progression, chemotherapy was recommended.Abbreviations: PR, partial response; SD, stable disease.The cut‐off time:October 15, 2021.The patient died for the disease progressed.The criteria for treatment adjustment and withdraw are as following: 1. Discontinued treatment due to grade 3 apatinib‐related toxic reactions, and then resumed after recovery to grade 2 or below; 2. If grade 3 reaction occurs again, suspending the drug. After and recovering to grade 2 or below, the dose should be halved; 3. If grade 3 reaction still occurs after lowering the dosage, withdrawal should be considered; 4. The patients asked for withdraw due intolerable or unwilling to take medicine; 5. The doctor considers that it is not appropriate to continue treatment.Changes in target lesion from baseline according to the best of response (A) and objective response at 6 months (B).Responses of 16 patients after combination treatment of ATRA and apatinib by October 15, 2021.Kaplan–Meier curve for progression‐free survival of 16 patients receiving combination therapy of ATRA and apatinib.During the treatment period, 12 patients (75%) finally discontinued the combination therapy for doctor advice or self‐discontinuation. Among them, nine progressed after 6.2–19.3 months of treatment, five of them finally discontinued treatment by doctors' advice, and three stopped by themselves. Among them, two were switched to other types of anti‐angiogenic drugs, two were switched to chemotherapy, and the others did not accept treatment. One patient was evaluated for PD in 25.6 month, but continued the combination therapy without discontinuing the medication, considering the drug accessibility and prior efficacy.