Zhejiang University, China
Title: Anlotinib combined with temozolomide therapy for patient of diffuse midline glioma: a case report
Qingsheng Xu, MD, PhD currently works in the Department of Neurosurgery in The First Affiliated Hospital, College of Medicine, Zhejiang University in China.
Diffuse midline glioma with histone H3-K27M mutation is a brand-new tumor entity according to 2016 edition of WHO classification. As diffuse midline gliomas are aggressive and incurable brain tumors, conventional treatment can hardly work, leading to the poor outcome of patients. Anlotinib is a newly developed oral small-molecule RTK inhibitor that targets VEGFR1, VEGFR2/KDR, VEGFR3, c-Kit, PDGFR-α, and FGFRs. Anlotinib can inhibit both tumor angiogenesis and tumor cell proliferation. It can inhibit more targets and has a better antiangiogenic activity than other target drugs. Therapeutic efficacy of anlotinib has been proved in advanced NSCLC, advanced STS, metastatic renal cell carcinoma, and advanced medullary thyroid cancer. Only mild side effects were discovered in these studies.
This case report presents a 51-year-old man suffering from diffuse midline glioma with histone H3-K27M mutation. After three cycles of temozolomide , the patient received radiotherapy with total DT of 5400cGy/20F, 200cGy/F, 5F/W, accompanied by chemotherapy of TMZ 75 mg/m2., then therapy with bevacizumab 5 mg/kg, Considering it was inconvenient for bevacizumab injection, we recommended adjusting the treatment plan to oral administration of anlotinib (10 mg qd d1-14, 21 days a cycle) plus TMZ (200 mg/m2, d1-5, 28 days a cycle). After 8 months treatment of anlotinib combined with temozolomide, MRI of this patient showed that the mass was significantly reduced compared to that before targeted therapy.
Our case firstly reported that anlotinib combined with TMZ was used for patients with diffuse midline glioma with histone H3-K27M mutation. Up till now, this patient has survived for 20 months.