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This study was designed to evaluate the efficacy and safety of apatinib in patients with advanced osteosarcoma and pulmonary metastases following failed first-line chemotherapy.There were 10 patients with osteosarcoma pulmonary metastases, whose first-line chemotherapy had failed, had received apatinib treatment as a single agent. All patients had at least 1 measurable lung tumor. Progression free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and treatment-related adverse effects (AEs) were reviewed and evaluated. Tumor response was assessed by response evaluation criteria in solid tumor criteria (RECIST). The 10 patients in this study received apatinib treatment for 2 to 16 months with a median of 7.5 months. The median PFS was 7.5 months. The 6-month, 8-month, and 10-month PFS rates were 60%, 40% and 26.6%, respectively. The median OS was 14 months. After 6-month apatinib treatment, 2 patients achieved partial response and 5 patients achieved stable disease, while 3 patients were evaluated as progression of the disease. At the 6-month follow-up, the ORR was 20.0% and the DCR was 70.0%. Hand-foot syndrome with grade 1/2 was the most common treatment-related AE. No drug-related severe AEs occurred.After failed first-line chemotherapy, apatinib as a single agent exhibited efficacy and acceptable safety in patients with advanced osteosarcoma and pulmonary metastases.