Surgery Plus Anlotinib Protocol

For patients in the surgery plus anlotinib cohort, the starting dose of anlotinib was 8 mg once a day for 2 weeks of treatment followed by the cessation of treatment for 1 week. Preoperative and postoperative medication should be used for at least 4 courses, respectively. Postoperative medication should be prolonged to 1 year as far as possible, and the medication regimen and specific time of postoperative withdrawal should be comprehensively determined according to whether the patient had recurrence and adverse reactions. The dose was reduced to 6 mg if the patient experienced intolerable or uncontrolled pharmaceutical-induced toxicity. If a patient had relapsed following surgery combined with anlotinib and was observed with progressive disease or clinical symptoms, the dose will be increased to 10 mg (Eisenhauer et al., 2009 (link)); if a patient developed refractory adverse reactions during the subsequent two cycles of 10 mg, the drug would be permanently discontinued and other treatment approaches would be employed.