Apatinib Combined With S-1 In Patients With Advanced Pancreatic Cancer Causing Sudden Massive Hemorrhage: Report Of Two Cases

Pancreatic cancer is the most malignant tumor of digestive system, and no effective treatment specifically for pancreatic cancer currently exists. Advanced pancreatic cancer chemotherapy, radiotherapy, and molecular targeted therapy might not be favorable and result in poor prognosis. Apatinib is currently being tested in patients with pancreatic or lung cancers. Here we report 2 cases using Apatinib and S-1 to treat advanced pancreatic cancer. Two patients had an adverse event involving sudden massive hemorrhage from the upper gastrointestinal tract and unfortunately died although after a timely rescue. Apatinib and gimeracil can cause gastrointestinal bleeding and may increase the risk of bleeding if combined with two drugs. We report these 2 cases with sudden massive hemorrhage with the objective of investigating the risk of anti-angiogenic drugs in patients with advanced pancreatic cancer. Furthermore, we provide reference for clinical rational drug use. In conclusion, suggestions on the clinical application of anti-angiogenic drugs should consider the risk of bleeding, especially in combination with chemotherapy.