Influence and mechanism of lung cavitation development on antiangiogenic therapy

Lung cavitation often occurs in lung cancer patients who have failed multiple lines of chemotherapy and have been treated with antiangiogenic agents (1,2). It is often considered a risk factor for the deterioration of a patient’s survival status (3). However, results may vary depending on the drug used. In a previous phase II trial, which included 67 non-small cell lung cancer (NSCLC) patients treated with bevacizumab, lung cavitation was associated with patient death (3). In another study of cediranib, Crabb et al. reported no clear link between clinical response and tumor cavitation in NSCLC patients (4). It is essential to study the relationship between lung cavitation development and antiangiogenic therapy to avoid serious adverse events and guide clinical treatments. Apatinib, a novel small-molecule vascular endothelial growth factor receptor (VEGFR) inhibitor, has been approved to treat advanced or metastatic chemorefractory gastric cancer in China (5,6). Recently, apatinib has been shown to have positive effects on multiple tumors, including lung cancer (6,7). According to our observations, apatinib-treated patients with lung lesions usually develop lung cavitation although the clinical significance of this finding has not been studied yet. Herein, we retrospectively reviewed apatinib-treated patients to evaluate the clinical significance of lung cavitation development during apatinib therapy (Clinical Trial Register No. NCT03629691). This is the first study concerning lung lesions of both primary and metastatic lung cancer. The study design was accepted as a poster at the 18th World Conference on Lung Cancer (WCLC, October 15–18, 2017, Yokohama, Japan P3.03-014)