Anlotinib as a post-third-line therapy for the treatment of advanced nonsmall cell lung cancer

Efficacy and safety of osimertinib plus anlotinib in advanced non-small-cell lung cancer patients after drug resistance

OBJECTIVE

To retrospectively analyze the efficacy and safety of osimertinib combined with anlotinib in the treatment of advanced non-small-cell lung cancer (NSCLC) after drug resistance, and to explore the related factors affecting the efficacy.

METHODS

The clinical data of 34 patients with advanced NSCLC who received osimertinib combined with anlotinib as three or more lines of treatment in the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College from June 2019 to March 2022 were collected, and the therapeutic efficacy and safety were analyzed.

RESULTS

A total of 34 advanced NSCLC patients met the inclusion criteria. The objective response rate was 20.6%, the disease response rate was 88.2%, the median overall survival was 19.0 months, and the median progression-free survival was 6.0 months. The common adverse events were mainly grade 1-2, and only three cases (11.1%) of adverse events were grade 3, including hypertension, proteinuria, and vomiting. No grade 4 or above adverse events were observed. Multivariate Cox regression analysis showed that the Eastern Cooperative Oncology Group Performance Status score and bone metastasis were independent prognostic factors for osimertinib combined with anlotinib as three or more lines of treatment in advanced NSCLC.

CONCLUSIONS

Osimertinib combined with anlotinib as three or more lines of treatment in advanced NSCLC was effective and adverse events were tolerable.

Exosomal miR-181a-3p Regulates the Anlotinib Resistance of Lung Cancer Cells

This study investigates the mechanism of Anlotinib in the treatment of lung cancer drug resistance. A total of 30 lung cancer tissue specimens were retrospectively analyzed and 30 normal lung tissues were included as a control. Real-time PCR detected miR-181a-3p expression along with analysis of cell viability by MTT assay, cell invasion by transwell, and the exosomal miR-181a-3p/UPR/ERAD signaling pathway. The expression of miR-181a-3p in peripheral blood of lung cancer was increased and the overall survival rate of patients with high miR-181a-3p in exosomes was shorter than patients with low expression. In A549 and H292 cell lines, anlotinib is added to overexpress exosomal miR-181a-3p, cell viability and invasion were significantly increased. After knocking down exosomal miR-181a-3p, cell viability and invasion were significantly reduced. The expression of miR-181a-3p is directly regulated by exosomes UPR/ERAD. After overexpression of exosomes miR-181a-3p, the protein levels of UPR and ERAD were significantly reduced and increased after knockdown of exosomes miR-181a-3p. In conclusion, the secretory miR-181a-3p/UPR/ERAD pathway promotes the proliferation of A549 and H292 cells, regulates the resistance of Anlotinib, and can increase the resistance of lung cancer to Anlotinib by promoting the proliferation signaling pathway, and promote the growth of tumor cells.

Efficacy and Safety of Drug-Eluting Bead Bronchial Arterial Chemoembolization Plus Anlotinib in Patients With Advanced Non-small-Cell Lung Cancer

Aim: The aim of this study is to determine the efficacy and safety of the combination therapy of drug-eluting bead bronchial arterial chemoembolization plus anlotinib oral administration in the treatment of non-small-cell lung cancer (NSCLC).

Methods: Consecutive data from 51 patients with advanced NSCLC were retrospectively collected from February 2018 to August 2019. All patients underwent drug-eluting bead bronchial arterial chemoembolization (DEB-BACE) followed by anlotinib treatment. Overall survival (OS) and progression-free survival (PFS) were calculated and analyzed using the Kaplan–Meier method and log-rank test, and factors associated with OS and PFS were assessed by a Cox proportional hazards test. Treatment response at 30 days was assessed by enhanced computed tomography (CT), and then the objective response rate (ORR) and disease control rate (DCR) were calculated. Treatment-related adverse events (TRAEs) were also evaluated.

Results: The median OS was 18.4 months (95% CI, 16.6–20.2 months), and the median PFS was 8.4 months (95% CI, 6.2–10.6 months). The ORR and DCR for the whole cohort were 21.6 and 100%, respectively, at 30 days after the first cycle of treatment. Most of the treatment-related adverse reactions were mild and moderate and included anorexia, hypertension, fatigue, and hand-foot syndrome. Only eight (15.7%) patients developed grade 3 TRAEs. No deaths or other serious adverse reactions occurred. Both TNM stage and brain metastasis were independent risk factors for OS and PFS.

Conclusion: DEB-BACE concomitant with anlotinib has promising efficacy and tolerable toxicity in patients with advanced NSCLC.