Lao Sun is an old patient of mine, advanced lung squamous cell carcinoma, chemotherapy combined with immunotherapy has been done many times, changed several programs, after chemotherapy, the physique is relatively poor, cancer cells have metastasized to the adrenal glands and liver. Considering that patients can no longer tolerate chemotherapy or immunotherapy, other hospitals recommend that patients take the small molecule-targeted drug anlotinib orally and review it regularly in the outpatient clinic. Oral administration for three months, the effect is still good, the primary lesion has shrunk, the metastasis is stable. For this result, Lao Sun and his family are still relatively satisfied, and feel that this medicine has played a role. However, last month, the family called to say that the old grandson was no longer there, that the big hemoptysis caused suffocation, and that he had not been rescued from the emergency room.
Recalling the treatment process, when oral anlotinib is administered, every time he comes to review the blood test, I have repeatedly advised that once there is a tendency to bleed, it is necessary to stop the drug quickly, such as nosebleeds, bleeding gums, hemoptysis, etc., otherwise major bleeding may be life-threatening. However, this unfortunate thing happened to him.
Anlotinib should be said to be not a new drug at present, as a multi-target anti-angiogenesis target drug of small molecules independently developed in China, the targets of action include VEGFR, PDGFR, FGFR, c-Kit, etc., with anti-angiogenesis and inhibition of tumor growth dual role. It has been on the market for more than three years and has a wide range of clinical applications.
In the guidelines for the treatment of lung cancer, anlotinib is recommended for the treatment of non-small cell lung cancer and small cell lung cancer in the third line and above. In esophageal cancer, anlotinib is also recommended in guidelines as a third-line and above medication. With the development of PD1 immunotherapy, there are also many clinical trials that say that anlotinib is combined with immunotherapy, which is equivalent to the combination of anti-angiogenesis drugs and immunotherapy drugs, which can play a synergistic effect.
In more than three years of clinical use, anlotinib has also played a great role, and many patients have obtained good efficacy. Compared with chemotherapy, the advantages of anlotinib are still many. As a small molecule drug, it is convenient to take it orally, and the side effects are significantly lower than that of systemic chemotherapy. Secondly, anlotinib is an anti-angiogenesis targeted drug, does not need to detect whether certain genes are mutated, can be used directly, for patients without sensitive gene mutations, is also a backline selection.
The overall side effects of anlotinib are small, including hypertension, proteinuria, fatigue, hand-foot syndrome, liver dysfunction, and thyroid dysfunction. In addition to the prevalence of hypertension, the incidence of other adverse reactions is not high.
However, the most terrible side effect of anlotinib is bleeding, which, as an anti-angiogenic drug, like bevacizumab, increases the tendency to bleed. In mild cases, gingival bleeding and nasal bleeding, in severe cases, there may be large hemoptysis, upper gastrointestinal bleeding, cerebral hemorrhage, hematuria, bloody stool, etc. Therefore, before taking it, we must check platelets and coagulation function, for central lung squamous cell carcinoma patients, large cavity lung cancer patients, ulcerated esophageal cancer patients, oral administration of this drug must be closely observed, once there is sputum with blood or gum bleeding and other conditions, to stop the drug in time or reduce the amount of observation.
The overall incidence of bleeding side effects is not high, but once a major bleeding occurs, the consequences can be very serious and may even be life-threatening. Therefore, during the oral administration of anlotinib, patients and family members should pay special attention to observation. In general, as long as the coagulation function is normal, choose the appropriate patient's standardized use, and observe closely, most people do not have to worry too much about their bleeding risk.