Introduction: Follicular dendritic cell sarcoma (FDCS) is a rare malignant tumor that lacks a standardized treatment plan. This report explores the efficacy and feasibility of the multi-target tyrosine kinase inhibitor (TKI) anlotinib as a first-line treatment through an indepth analysis of a case of advanced peritoneal FDCS. Case Presentation: An 83-year-old female patient was enrolled and received oral anlotinib therapy due to advanced disease stage, poor physical condition, and her family’s strong refusal of intravenous treatment. The treatment results showed that the patient achieved a significant partial response (PR), with a progression-free survival (PFS) of up to 15 months and an overall survival (OS) of 26 months, which far exceeded the treatment effects reported in the literature. Adverse reactions during anlotinib treatment were mild, and the lesions improved with increased dosages after the disease progressed, suggesting that this tumor may have adaptive rather than absolute resistance. Conclusion: This case provides valuable "real-world" evidence for the application of anlotinib in the treatment of advanced FDCS. Its success may stem from the close alignment between the drug's mechanism of action and the tumor's pathophysiology. However, this case also reveals unresolved issues, such as the complexity of FDCS diagnosis and the potential value of immunotherapy. Meanwhile, the clinical practice of targeted therapy further validates and promotes the value of molecular subtyping. Only by advancing the integration of molecular subtyping and targeted therapy can broader prospects be achieved for the precise diagnosis and treatment of FDCS.
Geng et al. (2026) studied this question.