Discussion
toxicities, bleeding, diarrhea, fatigue
BLEEDING, ADVERSE EVENTS, MUTANT, GIST, EVENTS
As a multi-target TKI, anlotinib has shown broader and stronger antitumor activity of in vitro studies than imatinib in KIT mutant GIST cells.The median PFS of anlotinib comparing with sunitinib in second-line therapy of metastatic GIST.The result in this study is very similar to the just released phase III study (INTRIGUE) of ripretinib versus sunitinib in GIST second-line treatment.There was another interesting phenomenon from subgroup analysis that the effect of anlotinib on GIST with exon 9 mutation was the worst compared with exon 11 mutation, which was just opposite to sunitinib as the second-line treatment for GIST.Encouragingly, safety data showed a good tolerance of the toxicities of anlotinib. The incidence of HFS, fatigue, diarrhea, and other adverse events was lower, especially, compared with sunitinib. Another noteworthy phenomenon is that none of the patients reduced the dose of anlotinib due to adverse events. However, a few cases of bleeding events still require further vigilance.In summary, anlotinib showed moderate antitumor activity in drug-resistant GIST cell lines in vitro, and acceptable PFS and good tolerance were obtained in this prospective study.