Case Report: Toripalimab Combined With Anlotinib in a Patient With Metastatic Upper Tract Urothelial Carcinoma After Pembrolizumab Failure.

Urothelial carcinoma is the most common primary upper tract urinary carcinoma. If surgery, chemotherapy, and immunotherapy fail, the prognosis for upper tract urinary carcinoma is extremely poor. Immunotherapy combined with antiangiogenesis therapy is a new therapeutic regimen with a synergistic antitumor effect. We present a case of metastatic upper tract urinary carcinoma in which the patient underwent surgery and treatment with gemcitabine combined with platinum-based chemotherapy. Radiotherapy and second-line immunotherapy (pembrolizumab) were administered after the cancer had progressed to the left lymph node of the abdominal aorta in the umbilical plane. However, the patient developed liver metastases while being treated with pembrolizumab. He was administered off-label immunotherapy (toripalimab) combined with antiangiogenesis therapy (anlotinib) and achieved a long-term clinical response for over 25 months. Toripalimab combined with anlotinib has potential therapeutic value for locally advanced or metastatic upper tract urinary carcinoma in patients who had previously received platinum-based chemotherapy and had disease progression or after treatment with a PD-1 inhibitor.

Efficacy and safety of lenvatinib versus sorafenib in first-line treatment of advanced hepatocellular carcinoma: A meta-analysis.

Objective: Lenvatinib and sorafenib are first-line oral multikinase inhibitors approved for the treatment of advanced hepatocellular carcinoma (HCC). However, the choice of the primary therapeutic agent among these two remains controversial. This meta-analysis aimed to estimate the efficacy and safety of lenvatinib and sorafenib in patients with advanced HCC. Methods: PubMed, Cochrane Library, Web of Science, and Embase databases were searched for relevant research published up to June 30, 2022. After quality assessment and data extraction of the included studies, RevMan 5.3 software was used for analysis. Odds ratio (OR) and hazard ratio (HR) with a 95% confidence interval (CI) were calculated using a fixed-effects or random-effects model. Results: Fifteen studies containing 3908 patients were included after final scrutiny. Our meta-analysis showed that there was no significant difference in overall survival (OS) between the lenvatinib and sorafenib groups (HR = 0.86; 95% CI: 0.72-1.02; p = 0.09); however, the progression-free survival (PFS) (HR = 0.63; 95% CI: 0.53-0.74; p < 0.00001), complete response (CR) (OR = 5.61; 95% CI: 2.71-11.64; p < 0.00001), partial response (PR) (OR = 4.62; 95% CI: 3.06-6.98; p < 0.00001), objective response rate (ORR) (OR = 5.61; 95% CI: 3.90-8.09; p < 0.00001), and disease control rate (DCR) (OR = 2.42; 95% CI: 1.79-3.28; p < 0.00001) in the lenvatinib group were significantly better than those in the sorafenib group. In terms of treatment safety, lenvatinib had similar incidences of any grade adverse events (AEs) (OR = 0.99; 95% CI: 0.47-2.09; p = 0.98) and grade ≥ 3 AEs (OR = 1.17, 95% CI; 1.00-1.37; p = 0.05) compared to sorafenib. Besides, lenvatinib was significantly associated with a higher incidence of hypertension, proteinuria, fatigue, decreased appetite, and weight loss, whereas sorafenib was associated with a higher incidence of diarrhea and hand-foot skin reaction (p < 0.05). Conclusion: Given its potential survival benefit and good tolerability, lenvatinib is an appropriate and promising alternative to sorafenib as first-line systemic therapy in patients with advanced HCC. Systematic review registration: https://www.crd.york.ac.uk/prospero/, identifier: CRD 42022327398.

The efficacy and safety of low-dose Apatinib in the management of stage IV luminal-type breast cancer: a case report and literature review.

Advanced breast cancer (ABC) is incurable. Previous studies have shown that vascular endothelial growth factor (VEGF) inhibitors play a significant role in the angiogenesis of breast carcinoma. Apatinib, a highly selective orally administered small-molecule tyrosine kinase inhibitor that targets vascular endothelial growth factor receptor-2 (VEGFR2) has successfully been used as a second- and third-line agent in the management of ABC. There are also multiple reported cases where Apatinib was miraculously effective in the management of triple-negative and HER2-positive tumors. However, case reports of its effectiveness against luminal-type tumors are rare. Here, we report the case of a 34-year-old woman with hormone receptor-positive and HER2-negative ABC who was successfully treated with low-dose Apatinib. Owing to necrosis of the center of the tumor due to the effective anticancer effect of Apatinib, a large cavity formed rapidly in the primary lesion; thus, the quality of life of the patient was seriously affected. This report aims to caution physicians about this unique phenomenon when using Apatinib in clinical practice.

Long-term clinical response of advanced lung adenocarcinoma to maintenance treatment of gemcitabine: A case report.

RATIONALE: Advanced non-small-cell lung cancer (NSCLC) is an aggressive malignancy that generally leads to poor outcomes, with <5% long-term survival at 5 years; however, several researches have shown improvements in the progression-free survival (PFS) and overall survival (OS) on the maintenance therapy after the first-line chemotherapy. we report a case of metastatic NSCLC patient treated with maintenance therapy of gemcitabine with brilliant results. PATIENT CONCERNS: Clinical data and treatment of a 68-year-old man with NSCLC are summarized. The Ethics Committee of People's hospital of Leshan, approved this study. DIAGNOSIS: Lung adenocarcinoma metastasized to the mediastinal lymph node, cervical lymph node, and adrenal gland, without epidermal growth factor receptor (EGFR) mutation. INTERVENTIONS: Continued treatment with gemcitabine alone following the 6 cycles of cisplatin-gemcitabine chemotherapy, prolonging the interval of chemotherapy when he could not tolerate the toxicity of the drug. OUTCOMES: Partial response of the disease for 4.5 years and significant clinical benefit. LESSONS: This case shows that patients will benefit from the maintenance therapy, and gemcitabine may be a good choice.