Primary Outcome Measure: efficacy and reasonable dosage of the combination of apatinib and
EGFR-TKI in advanced non-squamous non-small cell lung cancer with EGFR-TKI resistance.
Secondary Outcome Measures: Progression free survival, overall survival, Side effects.
1. Obtain of informed consent.
2. Histologically or cytologically confirmed, inoperable, recurrence or metastasis
advanced non-small cell lung cancer (TNM Stage ⅢB or stage Ⅳ), took EGFR-TKI longer
than 6 months and appeared disease progression.
3. At least one measurable lesion (helical CT scan long diameter ≥10mm, meet the
requirements of the standard Response Evaluation Criteria In Solid Tumors（RESCIST）
4. Eastern Cooperative Oncology Group（ECOG）Performance Status（PS） :0-2.
5. Aged from 18 to 75 years (18 and 75 years are included).
6. Life expectancy ≥12 weeks.
7. Adequate bone marrow reserve and organ function as follows:
- Absolute neutrophils count (ANC) ≥1.5 x 10 to the 9th power/L (band neutrophil
and segmented neutrophil), platelets > 100 x 10 to the 9th power/L and Hb≥90g/L.
- Hepatic: total bilirubin less than or equal to 1.5 times upper limit of normal
- Alkaline phosphatase (AP), alanine transaminase (ALT) and aspartate transaminase
(AST) less than or equal to 3.0 times ULN (or less than or equal to 5 times ULN
in case of known liver involvement.
- Renal: Serum Creatinine less than or equal to 1.25 times upper limit of normal
8. Have history of hypertension (less than 135/85mmHg).
9. Females of child-bearing potential must have negative serum pregnancy test. Sexually
active males and females (of childbearing potential) willing to practice contraception
during the study.
1. Do not meet the above criteria.
2. Prior treatment with VEGFR tyrosine kinase inhibitors or VEGFR targeting agent.
3. Unhealed toxicity of prior anti-cancer treatment (CTCAE Level 1) or surgery.
4. Symptomatic Central Nervous System (CNS) metastases.
5. Uncontrolled hypertension (systolic ≥140mmHg and/or diastolic ≥90mmHg after medication
6. Clinical uncontrolled active infection, such as acute pneumonia, active hepatitis B or
C (prior hepatitis B history, despite medication treatment control or not, HBV
DNA≥500copies or ≥100IU/ml), etc.
7. Arterial thrombosis or venous thrombosis in 6 months, or disposition evidence of
thrombosis/bleeding in 2 month (despite severity), hemoptysis in 2 weeks (bright red
blood, 1/2 teaspoon).
8. Stroke or transient ischemic attack (TIA) in 12 month.
9. Unhealed skin lesions, surgical site, injuries, severe mucous membrane ulcer or bone
10. Cardiac function evaluation: LVEF <50%, a recent history of MI in 6 months,
severe/unstable angina or coronary bypass surgery, or cardiac insufficiency ≥ NYHA 2.
11. Prior other malignant disease in 5 years (except carcinoma in situ of cervix, or non
melanoma skin cancers, or localized prostate cancer with Gleason ≤6).
12. Documented history of neurological or psychiatric disorders, include epilepsy and
13. Recent active digestive disease such as duodenal ulcers, ulcerative colitis, ileus,
ect., intestinal perforation, intestine fistula, or other conditions may lead to
gastrointestinal bleeding or perforation which regimented at investigators'
14. Difficulty swallowing or known malabsorption.
15. A history of organ transplantation and long-term immunosuppressive medication.
16. Take part in new drug clinical trials within one month or taking part in a trial now.
17. Pregnant or lactating woman.
18. A history of anaphylaxis of apatinib analogue and/or excipient of drugs in this study.
19. Other conditions regimented at investigators' discretion.