| Objective:To investigate the efficacy and safety of molecular targeted therapy apatinib mesylate monotherapy for advanced gastric cancer.Methods:1、Patients:From July 2015 to June 2017,the advanced gastric cancer patients who came to Shandong Provincial Hospital for the treatment.All selected patients refused conventional chemotherapy and signed informed consent.According to the inclusion and exclusion criteria,21 patients entered the final study in this group.2、Treatment:All patients were given a single oral apatinib mesylate treatment,the initial dose was 850 mg/d,for patients with serious adverse reactions,can be reduced to 500 mg/d of the therapeutic dose continue to take medication until the disease progresses,patient death,or intolerable drug-related adverse reactions.3、Observation indicators:The disease after treatment with apatinib mesylate had no progression of survival(PFS),total survival time(OS),efficacy evaluation(CR,PR,SD,PD)and safety(drug-related adverse reactions).Results:1、Objective efficacy:In all patients,there were no CR patients;PR patients were 3,SD patients were 13 and PD patients were 5.The ORR was 14.3%and the DCR was 76.2%.2、Survival and influencing factors:(1)The median progression-free survival(mPFS)was 7.6 months(95%confidence interval:6.55-8.65).There was a statistically significant difference in the degree of differentiation between high,moderate,and poorly differentiated gastric cancer patients(mPFS).9.2:7.2,P=0.044<0.05).The pathological type of adenocarcinoma was significantly different from that of other adenocarcinomas with adenocarcinoma and other components(mucinous adenocarcinoma or signet ring cell carcinoma)(8.3:5.2,P=0.001).<0.05).(2)The median overall survival time(mOS)was 10.2 months(95%confidence interval:7.51 to 12.88).The pathological type of adenocarcinoma was different from that of patients with pathological type adenocarcinoma and other components(mucinous adenocarcinoma or signet ring cell carcinoma).Statistically significant(10.6:7.4,P=0.001<0.05).3、Adverse Events:(1)The incidence of hypertension was 33.3%(7/21),and the incidence of hypertension above 3/4 was 4.8%(1/21).The incidence of proteinuria in all patients was 23.8%(5/21),all of which were grade 1/2,and no grade 3 or 4 severe patients were seen.A total of 6 patients had symptoms of hand-foot syndrome,5 patients showed grade 1/2,and grade 3 and 4 had a rate of 4.8%(1/21).Six patients experienced nausea and vomiting,all of which were mild(grade 1/2).Five patients had different degrees of diarrhea symptoms,the incidence was 23.8%,of which one patient showed grade 3.The incidence of erythrocyte reduction,leukopenia,and thrombocytopenia was 9.6%,23.8%,and 14.3%,respectively.Among them,one patient showed grade 3 leukopenia,and the others were grade 1 or grade 2.(2)Grade 1 and 2 adverse reactions were all well-reported after symptomatic treatment.Symptoms were well controlled and did not affect the patient’s normal medication.Among the patients with grade 3 or 4 adverse reactions,one case of hypertension and one case of hand-foot syndrome were treated with active symptomatic treatment and were relieved.The medication was continued regularly;1 patient with diarrhea and 1 patient with leukopenia were treated symptomatically.The effect was poor.After the dose of apatinib was reduced,the symptoms were controlled.After the dose was maintained at 500 mg/d,the treatment was continued.All adverse drug reactions occurred after the system’s symptomatic treatment or reduction of drug treatment returned to normal or mild conditions(level 1/2).(3)No drug-related deaths occurred during all patients taking the drug.Conclusion:1、Single oral apatinib is an effective treatment for advanced gastric cancer,improving patient’s disease-free survival time(PFS),improving the patient’s quality of life,and benefiting patients’ survival.2、The adverse events of taking apatinib were controlled and patients were well tolerated and can be used for the maintenance treatment of patients with advanced gastric cancer. |
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