Background: To date, there is no effective treatment for thromboangiitis obliterans (TAO). Anlotinib, as a third-line therapy, is recommended for patients with refractory advanced non-small cell lung cancer (NSCLC). We presented a case report of a patient suffering from right lung squamous cell carcinoma combined with thromboangiitis obliterans, and analyzed the treatment dilemma, which provided a new idea for the treatment of these two diseases.
Methods: A patient of right lung squamous cell carcinoma complicated with TAO was admitted to the department of respiratory and critical care medicine of the Shanghai General Hospital in August 2018. The diagnosis and treatment was retrospectively analyzed, and the literature was reviewed.
Results: The 73-year-old male patient complained of cough and sputum for 5 months and was diagnosed with NSCLC (T4N2M0, stage IIIb, performance status score 2) in right upper lung by tracheoscopy biopsy. Pigmentation in both lower extremities accompanied by weakened pulse of dorsal foot artery was confirmed. He had a history of smoking, and suspected vascular intermittent claudication and wandering phlebitis for more than one year. Ultrasound indicated multiple arterial occlusion in both upper and lower extremities and deep venous thrombosis in lower extremities. TAO was diagnosed. Peripherally inserted central catheter (PICC) implantation and intravenous infusion post implantation failed and he could not receive chemotherapy. Vascular endothelial growth factor (VEGF) signal pathway dysfunction is also involved in TAO. Anlotinib (12 mg qd po) was selected for treatment NSCLC and TAO, accordingly. He had partial response (PR) and the cancer kept stable for 14 months. At the same time, TAO improved.
Conclusions: Anlotinib effectively controlled the growth of NSCLC and improved TAO related symptoms. Anlotinib maybe normalize disordered growth of blood vessels through the VEGF signaling pathway, rather than simply inhibiting angiogenesis.
【中文题目：不同机制所致的血管紊乱化生长的共同干预——安罗替尼治疗右肺鳞癌合并血栓闭塞性脉管炎1例】 【中文摘要：肺目前为止血栓闭塞性脉管炎（thromboangiitis obliterans，TAO，又称Buerger disease）仍无理想的治疗方法。安罗替尼作为三线药物，指南推荐用于二线治疗后复发或进展的晚期非小细胞肺癌（non-small cell lung cancer, NSCLC）患者。分析1例右肺鳞癌合并血栓闭塞性脉管炎的治疗困境及疗效评价，为两种疾病的治疗提供新的思路。方法 回顾性分析了上海交通大学附属第一人民医院呼吸与危重症医学科2018年8月收治的1例右肺鳞癌合并血栓闭塞性脉管炎的诊断、治疗过程，并文献复习。结果 患者男性，73岁，因“咳嗽、咳痰5月”入院。查体双下肢色素沉着伴足背动脉搏动减弱。既往有吸烟史，可疑血管性间歇性跛行并游走性静脉炎一年余。胸部计算机断层扫描（computed tomography, CT）提示右上肺肿瘤伴阻塞性肺炎，气管镜活检证实为鳞癌；B超提示双上肢及双下肢多发动脉闭塞，下肢深静脉血栓。诊断考虑：右肺鳞癌（T4N2M0，IIIb期），体力状况（performance status, PS）评分2分；肺部感染；血栓闭塞性脉管炎。患者外周穿刺置入中心静脉导管（peripherally inserted central catheter, PICC）和静脉输液岗植入术均失败，无法进行化疗。结合文献检索，考虑TAO也可能存在血管内皮细胞生长因子（vascular endothelial growth factor , VEGF）信号通路紊乱，选择安罗替尼（12 mg qd po）治疗。患者耐受性良好，随访14个月，肺部病变持续空洞化并缩小，同时血栓闭塞性脉管炎好转。结论 该患者罹患鳞癌合并TAO，安罗替尼治疗可有效控制肺癌增长，同时改善TAO相关症状。安罗替尼可能通过阻断VEGF信号通路，纠正紊乱化生长的血管，而不仅仅是抑制血管生成。】 【中文关键词：安罗替尼；血管生长因子；血栓闭塞性脉管炎】.
Keywords: Anlotinib; Thromboangiitis obliterans; VEGFR.