Durable Response from Temozolomide Combined with Apatinib in a Pediatric Patient with Recurrent High-Grade Glioma: A Case Report

Abstract

High-Grade Gliomas (HGGs) are the most frequently diagnosed Central Nervous System (CNS) tumors in children. Maximal safe surgical resection is the cornerstone of management of pediatric HGGs. Radiation therapy is the standard of care after surgical resection and significantly improves survival of children older than 3 years-old with HGGs, but the recurrence rate of pediatric HGGs remains very high. Currently, there are no effective treatments for pediatric patients with recurrent HGGs, but inhibition of Vascular Endothelial Growth Factor (VEGF) pathway has shown promising clinical benefit in several clinical studies as it can reduce brain edema, lead to symptomatic relief. Temozolomide (TMZ) is a standard chemotherapeutic modality in treating adult patients with HGGs. In this case, we described a 3-year-old boy who received repeated surgery and proton beam radiation therapy due to severe clinical symptoms. He experienced recurrence 6 months after first surgical resection. Finally, he received Apatinib combined with temozolomide (TMZ) as salvage therapy and obtained a durable response with manageable adverse events. Though the effect of Apatinib combined with TMZ has been confirmed in adult patients with recurrent HGGs, the clinical benefit in pediatric patients with recurrent HGGs has not been investigated. We hope our case could provide a reference for clinicians in this region.