| Summary: | Abstract Background Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR‐TKI) acquired resistance was an inevitably events in NSCLC treatment. Aims Intending to overcome the acquired resistance of EGFR‐TKI. Materials & Methods A clinical trial was, we enrolled 12 patients who were slowly progressing on first‐generation EGFR‐TKI, and added apatinib when the patients got slow progression. Results Seven patients were included in the efficacy analysis. The median PFS2 of apatinib combined with EGFR‐TKI was 8.2 months (95% CI, 7.3 m‐NA), and the total PFS reached 20.9 months (95% CI, 17.3 m‐NA) when plus PFS1. All the adverse events were manageable. The median PFS was significantly longer for circulating tumor DNA (ctDNA)‐cleared patients (8.4 months; 95% CI, 8.2‐NA) than for those ctDNA not cleared (7.1 months; 95% CI, 6.9‐NA) (p = 0.0082). Discussion The addition of apatinib did improve the duration of first‐generation EGFR‐TKI use, and the duration was better than the first‐line use of third‐generation EGFR‐TKI. Conclusion The addition of apatinib when the patients got slow progression after initial EGFR‐TKI therapy may be a good treatment option and the side effects are controllable. It is possible to monitor treatment efficacy using ctDNA.
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