Patient case: 50-year-old male with non-small cell lung cancer; genetic feature: EGFR (T790M)

Clinical trial: A Study of Apatinib Plus EGFR-TKI as First Line Treatment in Patients With Non-squamous NSCLC Harboring EGFR Mutations

Summary: The purpose of this study is to evaluate the efficacy and safety of apatinib plus EGFR-TKI as first line treatment in patients with non-squamous NSCLC harboring EGFR mutation.


Eligibility: Inclusion Criteria:
  1. Age:18 to 75 years old (man or female);
  2. Pathologically diagnosed with non-squamous NSCLC;
  3. Imageology diagnosed with locally advanced/metastatic or recurrent (stage ⅢB - IV);
  4. Histologically or cytologic confirmed，harboring an activating EGFR mutation (19del or 21 L858R);
  5. None previous chemotherapy or targeted therapy.（NOTE: neoadjuvant and adjuvant therapy is allowed）;
  6. At least one measurable lesion (measuring≥10mm on spiral CT scan, satisfying the criteria in RECIST1.1)；
  7. Eastern Cooperative Oncology Group (ECOG) performance status of 0-2;
  8. Major organ function has to meet the following criteria:
  1. HB≥90g/L；
  2. ANC≥1.5×109/L；
  3. PLT≥80×109/L；
  4. ALT and AST≤2.5ULN, but≤5ULN if the transferanse elevation is due to liver metastases;
  5. TBIL≤1.5ULN;
  6. Serum creatinine≤1.25ULN; Endogenous creatinine clearance rate＞45 ml/min;
  9. Life expectancy greater than or equal to 3 months;
  10. Women of childbearing age must have contraceptive measures or have test pregnancy (serum or urine) enroll the study before 7 days, and the results must be negative, and take the methods of contraception during the test and the last to have drugs after 8 weeks. Men must be contraception or has sterilization surgery during the test and the last to have drugs after 8 weeks;
  11. Participants were willing to join in this study, and written informed consent, good adherence, cooperate with the follow-up.
  Exclusion Criteria:
  1. Have high blood pressure and antihypertensive drug treatment can not control (systolic blood pressure > 140 mmHg, diastolic blood pressure > 90 mmHg);
  2. Patients who suffered from grade II or above myocardial ischemia or myocardial infarction, uncontrolled arrhythmias (including QT interval male ≥ 450 ms, female ≥ 470 ms). Grade III-IV cardiac insufficiency according to New York Heart Association(NYHA) criteria or echocardiography check: left ventricular ejection fraction (LVEF)<50%;
  3. Radiologically documented evidence of major blood vessel invasion or encasement by cancer;
  4. A variety of factors influencing oral drugs (such as unable to swallow, nausea, vomiting, chronic diarrhea and intestinal obstruction, etc);
  5. Patients with tendency of gastrointestinal bleeding, including the following: a local active ulcerative lesions, and defecate occult blood (++). Has melena and hematemesis in two months;
  6. Coagulant function abnormality (INR > 1.5 ULN, APTT > 1.5 ULN), with bleeding tendency;
  7. Patients with pregnant or planning a pregnancy;
  8. Patients with other malignant tumors within 5 years (except for the treated skin basal cell carcinoma and cervical carcinoma in situ);
  9. History of psychiatric drugs abuse and can't quit or patients with mental disorders;
  10. Less than 4 weeks from the last clinical trial;
  11. The researchers think inappropriate.

Relevance to patient case: possibly relevant