Objective  To evaluate the efficacy and safety of apatinib in patients with refractory nasopharyngeal carcinoma and to identify the factors associated with poor prognosis.

  Methods  We reviewed 66 refractory nasopharyngeal carcinoma patients treated with apatinib in First Affiliated Hospital of Zhengzhou University. The Kaplan-Meier method and a Cox model were used to analyze the efficacy and the factors affecting survival.

  Results  The objective response rate (ORR) and disease control rate (DCR) of apatinib for refractory nasopharyngeal carcinoma were 33.33% and 54.55%, respectively. Median progression-free survival (PFS) was 7 95% confidence interval (CI): 2.816-11.184 months, and the median overall survival (OS) was 20 (95% CI: 11.496-28.504) months. All patients showed adverse reactions. The most common adverse reactions were proteinuria (40.90%, 27/66), hypertension (45.45%, 30/66), and hand-foot syndrome (37.88%; 25/66). No grade 4 adverse reactions occurred. Cox univariate analysis showed that lactate dehydrogenase (LDH) level was the factors influencing PFS, while WHO pathological type was the factor influencing OS.

  Conclusions  Apatinib therapy for refractory nasopharyngeal carcinoma may have certain curative effects, however, controllable adverse reactions were observed. Refractory nasopharyngeal carcinoma patients with good compliance who are not eligible for other treatment schemes can be considered for apatinib treatment. Further prospective studies with a large sample size are required to confirm the findings of this study.