Efficacy And Predictive Of Efficacy Analysis Of Apatinib In Third-line Treatment Of Metastatic Colorectal Cancer

BACKGROUNDColorectal cancer(CRC)is the third most common malignant tumor in the world.At present,the treatment of metastatic colorectal cancer has made great progress.The median survival period is nearly three years.Some patients can still receive third-line treatment after the failure of second-line treatment.Antineoplastic angiogenesis drugs have become an important treatment for metastatic colorectal cancer.Although anti-angiogenesis drugs have benefits,because of the lack of specific biological markers,they can not predict the efficacy,which limits the efficacy.It is particularly important to find the predictive factors of the efficacy.The application of Regfenil,an anticancer drug recommended for the third-line treatment of intestinal cancer,was limited by factors such as its domestic market in 2017,price and medical insurance reimbursement.At that time,there was no status quo of the third-line anti-vascular small molecule tyrosine kinase inhibitors in China.We need to explore new therapeutic drugs or new indications to improve treatment for patients with metastatic colorectal cancer who can still be treated after second-line chemotherapy fails,and explore possible predictors of the efficacy of antivascular drugs.Apatinib,a small molecular tyrosine kinase inhibitor(TKI)of vascular endothelial growth factor receptor-2(VEGFR-2),has been approved for the treatment of advanced gastric cancer or esophagogastric borderline adenocarcinoma in 2014.Limited studies on colorectal cancer have also suggested that apatinib has therapeutic benefits and controllable toxicity in metastatic colorectal cancer.Therefore,the purpose of this study is to retrospectively analyze the clinical efficacy of apatinib mesylate in the third-line treatment of metastatic colorectal cancer and the factors that may affect the prediction of curative effect in patients with metastatic colorectal cancer who failed to receive standard second-line treatment,so as to provide data for clinical treatment.METHODS:To collect the clinical data of 30 patients with metastatic colorectal cancer who failed or could not tolerate the standard second-line treatment from October 2015 to March 2018 and who received the third-line treatment of Apatinib.The patients took 500 mg of Apatinib tablets orally once a day for 28 days as a cycle.The efficacy,safety and predictive factors of the treatment were analyzed and evaluated.RESULT:The median PFS was 4.3 months,the median OS was 8.1 months,the one-year survival rate was 26.1%,and the two-year survival rate was 8.7%.The DCR(disease control rate)was 60%.The ORR(objective remission rate)was 16.7%,partial remission(PR)was 5 cases(16.7%),disease stability(SD)was 13 cases(43.3%)and disease progression(PD)was 12 cases(40%).2.Most adverse events,such as hypertension,proteinuria,hand-foot syndrome,elevated aminotransferase,fatigue,anemia,thrombocytopenia,leukopenia,oral mucositis and so on,are of degree Ⅰ or Ⅱ.There were 3 cases of grade III-IV hypertension(10%),2 cases of grade Ⅲ-Ⅳ proteinuria(6.6%)and 3 cases of grade III-IV hand-foot syndrome(10%).3.There were significant differences between PFS treated with Apatinib and CEA(<25ng/ml VS>25ng/ml),CerB2(++-++ VS-+),Ki67(≤50%VS>50%)(P<0.05),suggesting that there was a potential relationship between the efficacy of Apatinib and CEA(<25ng/l),CerB2(++),Ki67(>50%).CONCLUSION:The third-line treatment of Apatinib for metastatic colorectal cancer has a tendency to improve the curative effect and survival,and the tolerance of adverse reactions is acceptable.The therapeutic effect of Apatinib for patients with CEA value lower than 25ng/ml,CerB2 greater than ++,Ki67 more than 50%has a tendency to prolong,suggesting the potential predictive value of CEA,CerB2,Ki67.