Combined Use of Apatinib Mesylate and Vinorelbine Versus Single Use of Vinorelbine in Triple-negative Breast Cancer

Combined Use of Apatinib Mesylate and Vinorelbine Versus Single Use of Vinorelbine in Recurrent or Metastatic Triple-negative Breast Cancer: a Double-blinded Randomized Controlled Clinical Trial

To compare the therapeutic effect of vinorelbine used alone or combined with apatinib mesylate for recurrent or metastatic TNBC patients who have at least received one chemotherapy regimen, including anthracyclines and taxanes, providing clinical evidence for multi-line treatment options for advanced TNBC.

The emergence of new molecular targeted drugs provides new prospects for the treatment of advanced breast cancer; and its future therapeutic trend includes chemotherapy combined with molecular targeted therapy. Apatinib mesylate (Aitan), a novel small molecule anti-angiogenic agent, highly selectively inhibits the activity of vascular endothelial growth factor receptor-2 tyrosine kinase. Aitan also blocks the signaling of vascular endothelial growth factor binding to its receptor, thereby strongly inhibiting tumor angiogenesis and exerting anti-tumor effect.However, a randomized controlled clinical trial of apatinib combined with vinorelbine for TNBC has not been reported. The objective of this study is to compare the therapeutic effect of vinorelbine alone or combined with apatinib mesylate for recurrent or metastatic triple-negative breast cancer (TNBC) patients who have received at least two regimens containing anthracyclines and taxanes.

Inclusion Criteria:

• Female patients with recurrent or metastatic TNBC, as confirmed by histological or cytological examination
• Age 18-70 years old
• According to the Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1, there is at least one measurable lesion.
• The Eastern Cooperative Oncology Group (ECOG) scores 0-2
• Expected survival ≥ 12 weeks
• Negative for ER/PR
• All patients will be tested for bone marrow capacity, liver and renal functions within 7 days prior to enrollment
• Previous use of anthracyclines and/or taxanes
• The medication history of vinorelbine
• Female patients of childbearing age must take adequate contraception; otherwise the patients must be proven to be infertile
• No history of serious heart, lung, liver, and kidney diseases
• Provision of written informed consent

Exclusion Criteria:

• Patients who receive chemotherapy, radiation therapy, targeted drugs, or hormone therapy within 3 weeks of administration
• Patients using corticosteroids for untreated brain or subdural metastatic lesions, need to have stopped it, at least for 4 weeks or until there are no signs of brain metastasis and/or symptoms must have stabilized for at least 4 weeks, if local treatment has been completed. Enhanced computed tomography (CT) or magnetic resonance imaging (MRI) images during screening are compared with those performed at least 4 weeks earlier to determine radiological stability.
• Patients with severe vascular diseases, including unstable angina, myocardial infarction, or severe arrhythmia in the past 6 months
• History of HIV infection or active chronic hepatitis B or C
• Patients with other serious infectious diseases
• Patients positive for ER/PR/HER-2 positive
• Patients with allogeneic organ transplants requiring immunosuppressive therapy
• History of other malignant tumors within 5 years, except for cured cervical carcinoma in situ or basal cell carcinoma of the skin
• Other destabilizing factors that may interfere with patients or have an impact on the trial results
• Allergic to target drugs or allergic to related drugs applied in the trial
• Pregnant or lactating women