Anlotinib treatment for refractory peritumoral brain edema in brain metastases

Peritumoral brain edema (PTBE) in refractory brain metastases significantly reduces the quality of life and even threatens the lives of patients with brain metastases. Although the molecular mechanism of PTBE remains unclear, the important role of vascular endothelial growth factor (VEGF) expression and angiogenesis in PTBE has been confirmed. Therefore, tyrosine kinase inhibitors (TKIs) that block VEGF/VEGFR signaling and inhibit angiogenesis may have therapeutic effects. In this study, we report four cases of refractory peritumoral brain edema in brain metastases treated with anlotinib, a novel small-molecule multi-target TKI. All patients were diagnosed through core needle biopsy, with pathological results indicating non-small cell lung cancer, nasal melanoma, skin cancer, and breast cancer, respectively. They received standard multiline treatment during which multiple brain metastases occurred. Following chemotherapy resistance, anlotinib was used to treat the tumors and control refractory brain edema. After two cycles of treatment, brain edema and related symptoms improved, and anlotinib monotherapy was continued until disease progression. The main adverse reactions observed during treatment were hypertension and fatigue, which were tolerable. In this small case series, anlotinib was associated with marked radiological reduction of peritumoral brain edema and symptom relief in patients with refractory brain metastases, suggesting it may be a potential therapeutic option that warrants further investigation in larger studies.