Response to apatinib in chemotherapy-failed advanced spindle cell breast carcinoma

Oncotarget. 2016 Nov 1;7(44):72373-72379. doi: 10.18632/oncotarget.12568.

Abstract

Spindle cell carcinoma of the breast is a rare subtype of metaplastic carcinoma, and no effective chemotherapy special for metaplastic carcinoma exists until now. As spindle cell carcinomas of the breast are typically "Triple Negative", endocrine therapy and molecular therapy targeted to Her2 might not be favorable, resulting in poor prognosis. Apatinib is currently being tested in patients with breast or lung cancers. Here we report a successful case using Apatinib to treat spindle cell carcinoma of breast.A 52- year- old woman presented with a gradually enlarged lump in left breast, which was revealed to be a triple-negative spindle cell carcinoma, underwent a modified radical mastectomy. After the first line chemotherapy with Cyclophosphamide and Epirubicin, multiple metastases in bilateral lung and left anterior thoracic wall appeared. After disease progressed with therapy of Bevacizumab combined with Albumin-bound Paclitaxel and Cisplatin, we treated the patient with Apatinib according to her VEGFR expression, which showed nearly complete response and controllable and tolerated side effects. Next-generation sequencing analysis of the tumor specimen and real time ctDNA was performed to observe the mutated gene numbers matched with therapeutic effect. The present case can help to provide a new and effective therapy strategy to treat advanced spindle cell carcinoma.

Keywords: VEGFR; spindle cell carcinoma; targeted therapy; apatinib.

Publication types

  • Case Reports

MeSH terms

  • Albumin-Bound Paclitaxel / pharmacology
  • Albumin-Bound Paclitaxel / therapeutic use
  • Antineoplastic Agents / therapeutic use*
  • Antineoplastic Combined Chemotherapy Protocols / pharmacology*
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Bevacizumab / pharmacology
  • Bevacizumab / therapeutic use
  • Biomarkers, Tumor / analysis
  • Breast / diagnostic imaging
  • Breast / pathology
  • Breast / surgery
  • Carcinoma / diagnostic imaging
  • Carcinoma / drug therapy*
  • Carcinoma / genetics
  • Carcinoma / secondary
  • Chemotherapy, Adjuvant / methods
  • Circulating Tumor DNA / isolation & purification
  • Cisplatin / pharmacology
  • Cisplatin / therapeutic use
  • Cyclophosphamide / pharmacology
  • Cyclophosphamide / therapeutic use
  • Disease Progression
  • Drug Resistance, Neoplasm*
  • Epirubicin / pharmacology
  • Epirubicin / therapeutic use
  • ErbB Receptors / genetics
  • ErbB Receptors / metabolism
  • Female
  • Hand-Foot Syndrome / etiology
  • High-Throughput Nucleotide Sequencing
  • Humans
  • Hypertension / chemically induced
  • Lung Neoplasms / diagnostic imaging
  • Lung Neoplasms / drug therapy
  • Lung Neoplasms / genetics
  • Lung Neoplasms / secondary
  • Mastectomy, Modified Radical
  • Middle Aged
  • Mutation
  • Neovascularization, Pathologic / drug therapy
  • Positron Emission Tomography Computed Tomography
  • Protein Kinase Inhibitors / therapeutic use
  • Pyridines / therapeutic use*
  • Receptors, Vascular Endothelial Growth Factor / genetics
  • Receptors, Vascular Endothelial Growth Factor / metabolism
  • Sequence Analysis, DNA / methods
  • Thoracic Neoplasms / diagnostic imaging
  • Thoracic Neoplasms / drug therapy
  • Thoracic Neoplasms / genetics
  • Thoracic Neoplasms / secondary
  • Treatment Failure
  • Triple Negative Breast Neoplasms / drug therapy*
  • Triple Negative Breast Neoplasms / genetics
  • Triple Negative Breast Neoplasms / pathology
  • Triple Negative Breast Neoplasms / surgery

Substances

  • Albumin-Bound Paclitaxel
  • Antineoplastic Agents
  • Biomarkers, Tumor
  • Circulating Tumor DNA
  • Protein Kinase Inhibitors
  • Pyridines
  • Bevacizumab
  • Epirubicin
  • apatinib
  • Cyclophosphamide
  • EGFR protein, human
  • ErbB Receptors
  • Receptors, Vascular Endothelial Growth Factor
  • Cisplatin