apatinib + irinotecan + temozolomide

Apatinib + irinotecan + temozolomide is an investigational combination regimen consisting of three small molecule drugs—apatinib, irinotecan, and temozolomide—used primarily in the treatment of relapsed or refractory neuroblastoma. Apatinib is a selective inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2), blocking angiogenesis in tumors. Irinotecan is a topoisomerase I inhibitor that interferes with DNA replication, while temozolomide is an oral alkylating agent causing DNA damage in cancer cells. The combination has shown promising efficacy and tolerability in phase 2 trials, with high response and disease control rates in pediatric and adult patients. The regimen is generally administered in 21-day cycles, with apatinib taken orally and irinotecan and temozolomide given intravenously or orally, depending on protocol. Post-combination, apatinib maintenance therapy may be continued alone. The regimen is primarily investigated in China and is not yet approved for general use[1][2][10].