Management of Apatinib-Related Adverse Events in Patients With Advanced Osteosarcoma From Four Prospective Trials: Chinese Sarcoma Study Group Experience
Open accessAbstract
Four prospective trials have reported apatinib-related efficacy in osteosarcoma, with a high response rate of 43.2%. Currently, Adverse Events (AEs) have increasingly gained attention, as treatment with multiple tyrosine kinase inhibitors (TKIs) is potentially lifelong. For this reason, a consensus meeting of the Chinese Sarcoma Study Group (CSSG), which is a multidisciplinary panel composed of pediatric, medical and surgical oncologists specializing in sarcoma, nurse specialists, oncological senior pharmacists and gastroenterologists, was held to develop comprehensive guidelines on AEs emerging due to apatinib treatment to better assist in the prevention, management, and understanding of AE development. We summarized all AEs that arose in ≥10% of the participants as well as rare AEs that required extra caution to prevent that were observed in these four published prospective trials and arranged these AEs into 14 disorder systems according to CTCAE 5.0. In this review, we discuss strategies for the management of AEs in patients with advanced osteosarcoma, with the aim of maximizing treatment benefits and minimizing the need for apatinib treatment discontinuation. We also focus on providing recommendations for the prophylaxis and treatment of advanced osteosarcoma using apatinib to achieve optimal outcomes.
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In the authors' previous retrospective study, the most prominent adverse event associated with the combination therapy was ifosfamide-induced encephalopathy, occurring more frequently and with greater severity than typically reported, partly due to apatinib-induced hypoalbuminemia and hypertension.
“the most prominent AE associated with the combination therapy was ifosfamide-induced encephalopathy, occurring more frequently and with greater severity than typically reported14, partly due to apatinib-induced hypoalbuminemia and hypertension15”
From Apatinib plus ifosfamide and etoposide versus ifosfamide and etoposide in patients with advanced osteosarcomas (OAIE/PKUPH-sarcoma 11): a randomized phase II study (2025) · cites this paper as [15]
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- Authors
- Xie, L., Xu, J., Guo, W., Wang, Z., Yao, Y., Li, J., Lin, J., Xiao, J., Yu, X., Zhang, W., Cai, Z., Hua, Y., Chen, J., Shao, Z., Wu, D., Wu, S., Tu, Z., & Zhang, X.
- Affiliations
- Peking University People's Hospital (CN)
- Xijing Hospital (CN)
- Shanghai Sixth People's Hospital (CN)
- Qilu Hospital of Shandong University (CN)
- First Affiliated Hospital of Fujian Medical University (CN)
- Shanghai Changzheng Hospital (CN)
- Jinan Military General Hospital (CN)
- Shanghai Jiao Tong University (CN)
- Shanghai First People's Hospital (CN)
- Wuhan Union Hospital (CN)
- Jilin University (CN)
- Nanjing General Hospital of Nanjing Military Command (CN)
- Liaoning Cancer Hospital & Institute (CN)
- Corresponding author
- Guo, Wei
- ORCID
- Venue
- Frontiers in Oncology
- Publisher
- Frontiers Media SA
- Published
- 2021-07-22
- Volume
- 11
- Pages
- 696865-696865
- ISSN
- 2234-943X (ISSN-L)
- PMC
- PMC8339966
- OpenAlex
- W3183208068
- Cited by
- 9
- References
- 63
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2023: 1 · 2022: 3
- FWCI
- 0.20
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Oncology (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Greater South Information System
- Funders
- Foundation for Innovative Research Groups of the National Natural Science Foundation of China
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Sarcoma Diagnosis and Treatment
- Health Sciences › Medicine › Rheumatology › Bone Tumor Diagnosis and Treatments
- Life Sciences › Immunology and Microbiology › Immunology › Biosimilars and Bioanalytical Methods
- Keywords
- apatinib, adverse event management, tyrosine kinase inhibitors, consensus recommendations, CTCAE 5.0, treatment discontinuation, pediatric oncology
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