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Review ArticleReview

Anlotinib has good efficacy and low toxicity: a phase II study of anlotinib in pre-treated HER-2 negative metastatic breast cancer

Nanlin Hu, Yiran Si, Jian Yue, Tingting Sun, Xue Wang, Zhuqing Jia, Songlin Gao, Qiao Li, Yang Shao, Jiayu Wang, Yang Luo, Fei Ma, Binghe Xu and Peng Yuan
Cancer Biology & Medicine August 2021, 18 (3) 849-859; DOI: https://doi.org/10.20892/j.issn.2095-3941.2020.0463
Nanlin Hu
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Yiran Si
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Jian Yue
2Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Tingting Sun
3Nanjing Geneseeq Technology Inc., Nanjing 210032, China
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Xue Wang
2Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Zhuqing Jia
4Cancer Hospital of Huanxing Chaoyang District Beijing, Beijing 100021, China
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Songlin Gao
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Qiao Li
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Yang Shao
3Nanjing Geneseeq Technology Inc., Nanjing 210032, China
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Jiayu Wang
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Yang Luo
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Fei Ma
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Binghe Xu
1Department of Medical Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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Peng Yuan
2Department of VIP Medical Services, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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  • ORCID record for Peng Yuan
  • For correspondence: yuanpeng01{at}hotmail.com
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Article Figures & Data

Figures

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  • Waterfall plot of the best percentage change in target lesion size.
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    Figure 1

    Waterfall plot of the best percentage change in target lesion size.

  • Kaplan-Meier graph showing progression-free survival. (A) The median progression-free survival (PFS) of all patients (n = 26) was 5.22 months. (B) The median PFS of hormone receptor-positive (n = 16) and hormone receptor-negative (n = 10) patients was 5.88 months and 4.04 months, respectively, HR = 0.62, 95% CI (0.24–1.63), P = 0.32.
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    Figure 2

    Kaplan-Meier graph showing progression-free survival. (A) The median progression-free survival (PFS) of all patients (n = 26) was 5.22 months. (B) The median PFS of hormone receptor-positive (n = 16) and hormone receptor-negative (n = 10) patients was 5.88 months and 4.04 months, respectively, HR = 0.62, 95% CI (0.24–1.63), P = 0.32.

  • Distribution of the top 25 genomic alterations in the entire population at baseline.
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    Figure 3

    Distribution of the top 25 genomic alterations in the entire population at baseline.

Tables

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    Table 1

    Patient characteristics at baseline

    CharacteristicsAnlotinib
    Total (n = 26)Hormone receptor positive (n = 16)Hormone receptor negative (n = 10)
    Age, median (range)56 (30–75)56 (30–75)50 (32–64)
    Age (years), n (%)
     ≥ 653 (11.54)3 (18.75)0
     < 6523 (88.46)13 (81.25)10 (100)
    ECOG, n (%)
     07 (26.92)5 (31.25)2 (20.00)
     116 (61.54)10 (62.50)6 (60.00)
     23 (11.54)1 (6.25)2 (20.00)
    Hormone receptor, n (%)
     Positive16 (61.54)16 (100)0
     Negative10 (38.46)010 (100)
    Type of metastatic site, n (%)
     Non-visceral4 (15.38)2 (12.50)2 (20.00)
     Visceral22 (84.62)14 (87.50)8 (80.00)
    Number of metastatic sites, n (%)
     13 (11.54)2 (12.50)1 (10.00)
     212 (46.15)7 (43.75)5 (50.00)
     ≥ 311 (42.31)7 (43.75)4 (40.00)
    Metastatic site, n (%)
     Lymph nodes13 (50.00)7 (43.75)6 (60.00)
     Liver9 (34.62)8 (50.00)1 (10.00)
     Lung17 (65.38)9 (56.25)8 (80.00)
     Pleural effusion6 (23.08)3 (18.75)3 (30.00)
     Chest wall2 (7.69)1 (6.25)1 (10.00)
     Pericardial effusion2 (7.69)02 (20.00)
     Bone15 (57.69)12 (75.00)3 (30.00)
    Neoadjuvant, n (%)
     Yes3 (11.54)1 (6.25)2 (20.00)
     No23 (88.46)15 (93.75)8 (80.00)
    Adjuvant chemotherapy, n (%)
     Yes23 (88.46)15 (93.75)10 (100)
     No3 (11.54)1 (6.25)0
    Adjuvant endocrine therapy, n (%)
     Yes16 (61.54)16 (100)0
     No10 (38.46)010 (100)
    Previous lines of systematic treatment, n (%)
     ≤ 214 (53.85)8 (50.00)6 (60.00)
     ≥ 312 (46.15)8 (50.00)4 (40.00)
    Type of previous endocrine therapy combined with target therapy, n (%)
      Both CDK/4/6 inhibitor and mTOR inhibitor3 (11.54)3 3 (18.75)0
     Only CDK4/6 inhibitor2 (7.69)2 (12.50)0
     Only mTOR inhibitor2 (7.69)2 (12.50)0
    Previous chemotherapy after metastasis, n (%)
     Taxanes26 (100)16 (100)10 (100)
     Fluorouracil†22 (84.62)12 (75.00)10 (100)
     Platinum10 (38.46)3 (18.75)7 (70.00)
     Others‡17 (65.38)10 (62.50)7 (70.00)

    ECOG, Eastern Cooperative Oncology Group.†Including capecitabine and S-1. ‡Other drugs, including gemcitabine, vinorelbine, and etoposide.

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      Table 2

      Treatment response

      TotalHormone receptor positiveHormone receptor negativeStatistics
      Numbers261610
      ORR (%)15.3818.7510
      95% CI(4.36–34.87)(4.05–45.65)(0.25–44.50)P = 1.00†
      DCR (%)80.7787.570
      95% CI(60.65–93.45)(61.65–98.45)(34.75–93.33)P = 0.34‡
      Numbers censoring, n (%)8 (30.77)6 (37.50)2 (20.00)
      Median PFS5.225.884.04
      95% CI(2.86–6.24)(1.94–8.87)(1.87–6.24)
      HR§–––0.62, χ2 = 0.9595
      95% CI§–––(0.24–1.63), P = 0.32

      PFS, progression-free survival; CI, confidence interval; HR, hazard ratio; ORR, objective response rate; DCR, disease control rate.†The ORR/DCR comparison between groups (positive vs. triple negative) was analyzed with Fisher’s exact test. ‡The 95% CI of the ORR/DCR was calculated with the Clopper-Pearson method. §The comparison of progression-free survival between 2 groups (hormone receptor positive vs. hormone receptor negative) was performed with a log-rank test. The HR and 95% CI (hormone receptor positive vs. hormone receptor negative) were estimated with the Cox proportional-hazards model.

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        Table 3

        Summary of treatment-related adverse events

        Adverse eventsAll grades, n (%)Grade 1, n (%)Grade 2, n (%)Grades 3–4, n (%)
        Fatigue4 (15.38)3 (11.54)1 (3.85)0 (0)
        Anorexia2 (7.69)0 (0)2 (7.69)0 (0)
        Weight loss1 (3.85)1 (3.85)0 (0)0 (0)
        Pharyngalgia3 (11.54)3 (11.54)0 (0)0 (0)
        Mucositis oral1 (3.85)1 (3.85)0 (0)0 (0)
        Cough2 (7.69)2 (7.69)0 (0)0 (0)
        Hand-foot syndrome6 (23.08)5 (19.23)0 (0)1 (3.85)
        Urinary tract infection1 (3.85)0 (0)1 (3.85)0 (0)
        Hematuria2 (7.69)2 (7.69)0 (0)0 (0)
        Proteinuria4 (15.38)4 (15.38)0 (0)0 (0)
        Hypertension15 (57.69)4 (15.38)4 (15.38)7 (26.92)
        TSH elevation9 (34.62)9 (34.62)0 (0)0 (0)
        Hypothyroidism2 (7.69)2 (7.69)0 (0)0 (0)
        Hypertriglyceridemia1 (3.85)1 (3.85)0 (0)0 (0)
        Hypercholesterolemia1 (3.85)1 (3.85)0 (0)0 (0)
        LDL elevation2 (7.69)2 (7.69)0 (0)0 (0)
        Alanine aminotransferase2 (7.69)1 (3.85)1 (3.85)0 (0)
        Aspartate aminotransferase1 (3.85)0 (0)1 (3.85)0 (0)

        LDL, low-density lipoprotein; TSH, thyroid-stimulating hormone.

        Supplementary Materials

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        Cancer Biology and Medicine: 18 (3)
        Cancer Biology & Medicine
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        1 Aug 2021
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        Anlotinib has good efficacy and low toxicity: a phase II study of anlotinib in pre-treated HER-2 negative metastatic breast cancer
        Nanlin Hu, Yiran Si, Jian Yue, Tingting Sun, Xue Wang, Zhuqing Jia, Songlin Gao, Qiao Li, Yang Shao, Jiayu Wang, Yang Luo, Fei Ma, Binghe Xu, Peng Yuan
        Cancer Biology & Medicine Aug 2021, 18 (3) 849-859; DOI: 10.20892/j.issn.2095-3941.2020.0463

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        Anlotinib has good efficacy and low toxicity: a phase II study of anlotinib in pre-treated HER-2 negative metastatic breast cancer
        Nanlin Hu, Yiran Si, Jian Yue, Tingting Sun, Xue Wang, Zhuqing Jia, Songlin Gao, Qiao Li, Yang Shao, Jiayu Wang, Yang Luo, Fei Ma, Binghe Xu, Peng Yuan
        Cancer Biology & Medicine Aug 2021, 18 (3) 849-859; DOI: 10.20892/j.issn.2095-3941.2020.0463
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        Keywords

        • anlotinib
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