• Chu Zhang, Guang-Mao Yu, Miao Zhang, and Dong Liu.
• Department of Thoracic Surgery, Shaoxing People's Hospital (Shaoxing Hospital, Zhejiang University School of Medicine), Shaoxing.
• Medicine (Baltimore). 2020 Jan 1; 99 (1): e18691e18691.

RationaleApatinib has been proven to significantly prolong the survival of the patients with advanced chemotherapy-refractory gastric cancer. To date, studies on apatinib plus S-1 as first-line palliative therapy for metastatic gastroesophageal junction (GEJ) cancer are rare.Patient ConcernsA 61-year-old female patient was admitted with dysphagia, significant loss of body weight, and poor performance status.DiagnosesEndoscopic biopsy revealed the diagnosis of poorly-differentiated GEJ adenocarcinoma, and the patient was clinically staged as T3NxM1G3 (IVB).InterventionsShe had received 4 cycles of palliative therapy using oral apatinib (425 mg daily) plus S-1 (40 mg twice daily for 4 weeks, with a 2-week drug-free interval), followed by maintenance low-dose apatinib (250 mg daily) plus S-1 at the same dosage thereafter.OutcomesHer progression-free survival was nearly 5 months, and the overall survival was >11 months up to now. The adverse events were tolerable.LessonsApatinib plus S-1 might be an alternative option for late-stage GEJ cancer. However, high-quality trials are warranted before the recommendation of this therapeutic regimen.

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