In 2013, a 50-year-old man patient visited hospital complaining of local bone pain in the left leg.
On August 14, 2013, the patient underwent a left distal femoral tumor en bloc resection and reconstruction with a modular femoral prosthetic system.
Pathology diagnosis confirmed osteoblastic osteosarcoma (Fig.2).
One cycle of neoadjuvant chemotherapy and 4 cycles of adjuvant chemotherapy with MAP regimen (high-dose methotrexate, cisplatin, and doxorubicin) were administered.
In January 2015, a mass was found on the left upper crus area.
Tumor recurrence was confirmed by biopsy on January 23, 2015.
However, only an upper femur amputation was carried out, as the patient refused hip joint replacement.
After wound healing, the patient went back to his normal life in the help of artificial limb, but refused to receive further chemotherapy due to concerns regarding the chemotherapy toxicities such as nausea, vomiting, leucopenia, deadlimb, and headache.
About half a year after the amputation, the patient got occasional cough and chest tightness.
Then a thin chest computed tomography (CT) was performed on July 15, 2015.
The CT results revealed multiple pulmonary nodules (Table ​1), considering the possibility of metastases.
The patient still rejected further chemotherapy.
Immunophenotype was suggestive of CD31+ and CD34+ tumor cells (Fig.3).
Furthermore, most cells showed strong positive staining for VEGFR-2 (Fig.3).
Apatinib was administered at a dose of 500 mg daily.
Half a month later, the symptoms disappeared, but a progressive wound necrosis appeared.
A debridement surgery was finally conducted and an enlarged lymph node near iliac vessels was resected on February 24, 2016 (Fig.(Fig.4).4).
The result of pathological examination revealed an inflammatory hyperplasia lymph node.
Apatinib administration was stopped during the 3 weeks of wound healing period.
The thin chest CT was performed 7 and 11 months following apatinib administration.
At the 7-month follow-up time point, 2 out of 5 measurable and 9 out of 17 non-measurable lesions disappeared, but 1 new measurable nodule and 6 new non-measurable lesions were observed (Table ​1, Fig.5), which considered PD according to the Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 standard.
However, at the 11-month follow-up time point, a total of 9 lesions disappeared, including 1 measurable nodule and 2 non-measurable lesions presented before apatinib treatment as well as 6 non-measureable lesions presented 7 months after apatinib treatment.
No new lesion was raised.
After target lesion measurement according to the RECIST 1.1 standard, it was narrowly considered PR.
The toxicities the patient experienced included mild hand-foot syndrome and slight high blood pressure.
Both were well controlled after appropriate treatment.
No severe toxicities and other treatment-related adverse events were observed.
The patient continued to use apatinib as maintenance therapy without major toxic effects, and went back to normal life, even driving an automatic car.