Abstract
There are fewer treatments in for patients with HER2-negative breast cancer than for HER2-positive patients, especially for metastatic breast cancer. Apatinib is a small-molecule tyrosine kinase inhibitor that selectively targets VEGFR-2. Apatinib was prescribed orally at a dose of 250mg once daily. If conditions permitted, patients also received an NGS test before treatment. The median PFS of the 115 patients was 4.0 months. The objective response rate was 25.5%, and the disease control rate was 80.9%. Univariate analysis showed that patients without liver metastases before treatment were given longer PFS (4.4 months vs. 3.0 months, p=0.022), and that patients with hypertension or hand-foot syndrome during treatment had significantly longer PFS (hypertension: 4.4 vs 3.0 months, p=0.010; Hand-foot syndrome: 4.7 vs 3.3 months, p=0.016). NGS found that patients with BRCA mutations had significantly longer PFS (10.5 months versus 2.6 months, p=0.023). In addition, there were 15 patients having continued to treat with apatinib combined with another chemotherapy agent after PD for first time, the PFS slightly extended (5.2 vs. 4.0 months), but no statistical difference (p =6.22). Most of the adverse effects were grade 1 to 2. Low-dose apatinib is a new choice after failure of multi-line treatment for HER2-negative breast cancer, and the adverse reactions are well tolerated. Through NGS detection to find the predictive factors of apatinib, to the first time, we found that patients with BRCA mutations had longer PFS. Moreover, patients without liver metastasis received significantly longer PFS, suggesting the organ selectivity of apatinib treatment. It provides effective evidence for the clinical use of low-dose apatinib in HER2-negative advanced breast cancer. We believe that patients with HER2-negative advanced breast cancer should choose low-dose apatinib to increase the efficacy, especially those with BRCA mutations.
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