Discussions
toxicity, toxicities, gastric cancer
SOLID TUMORS, TUMORIGENESIS, GASTRIC CANCER
To our knowledge, this is the first study assessing the efficacy and safety of apatinib plus capecitabine for treating RM-NPC in the second-line or more settings. Our primary endpoint was met with a confirmed objective response observed in 39.1% of patients. Most toxicities were manageable with clinical interventions, dose reduction, and interruption, suggesting that this combination therapy is a feasible option for platinum-refractory RM-NPC.Angiogenesis is the hallmark of tumorigenesis and is promoted by the expression of VEGF. Reported overexpression of VEGF in the NPC microenvironment is the foundation of the application of anti-angiogenesis drugs in NPC [In recent years, immunotherapy has made great progress in treating different solid tumors, including NPC. Compared to the trials that assessed the anti-tumor activity of different PD-1 antibody monotherapies in pretreated RM-NPC, the ORR from our study was slightly higher (39.1% vs. 20.5–34%), as was the median PFS (7.5 months vs. 1.9–6.5 months) [The recommended dose for apatinib in gastric cancer was 850 mg [The current study has several limitations. This was a single-arm study with no comparative group; therefore, the comparison of efficacy between this study and historical data lacked power. The enrolled patients were heterogenous, including both the recurrent and metastatic patients, and some of them had received multiple lines of chemotherapy. Besides, as confined by the small sample size, we were unable to find out which patients benefited more from the combination therapy. We did not collect quality of life prospectively due to the lack of expectation of AEs. Meanwhile, certain difficulties also existed in the collection of patient-reported outcomes in the outpatient clinic. Therefore, we could not know whether the high toxicity of apatinib plus capecitabine at the study dose level affects patients’ quality of life. However, given the high proportion of dose reduction and high incidence of toxicities, lower initial doses of apatinib and capecitabine should be considered in future studies.