Observation Of Clinical Efficacy Of Apatinib Mesylate Combined With Chemotherapy In The Treatment Of Advanced Gastric Cancer With Cancerous Ascites

BackgroundGastric cancer is one of the most serious malignant tumors in the world,with the fifth highest incidence and the third highest mortality rate.However,the incidence and mortality of gastric cancer are unevenly distributed worldwide.More than half of all cases occur in East Asia,Central and Eastern Europe,and Central and South America,especially Japan and China.Although it is possible to improve nutritional content and use anti-helicobacter pylori treatment,the incidence and mortality of gastric cancer has steadily decreased.The disease still poses a huge threat to human health,leading to poor diagnosis and prognosis for patients with gastric cancer.The five-year survival rate of patients with severe gastric cancer is still very low.As a developing country in China,Human understanding of physical examination is relatively weak.Because the early clinical symptoms of stomach cancer are not typical,the existing circulating tissue can be used to diagnose and predict stomach cancer.These markers also showed low sensitivity and specificity,leading to a high proportion of patients with advanced stomach cancer in China.When gastric cancer is not suitable for surgical resection,palliative chemotherapy is the main treatment and is usually diagnosed as advanced(locally advanced or metastatic).The prognosis for advanced gastric cancer is rather poor,with an overall survival(OS)of less than 12 months.For patients with well-performing advanced gastric cancer,chemotherapy is the standard first-line treatment option.For patients with human epidermal growth factor 2 negative tumors,fluoropyrimidine(such as 5-fluorouracil,capecitabine,or S-1),platinum reagents(such as cisplatin or oxaliplatin),and taxanes(Such as docetaxel).Patients with HER-2 positive tumors should also receive trastuzumab.To further improve the treatment effect,second-line chemotherapy is routinely performed.Treatment options include docetaxel,paclitaxel or irinotecan monotherapy or anti-vascular endothelial growth factor receptor 2 antibody ramocilizumab alone or in combination with paclitaxel.However,almost all patients with advanced disease will continue to progress after treatment.Currently,new approaches focus on molecular-driven therapy and immunotherapy.For patients with advanced gastric cancer,ascites and peritoneal metastasis are the most common complications,which can cause a variety of symptoms and serious complications,such as intestinal obstruction,bile duct obstruction,and hydronephrosis.Some reports suggest that the presence of ascites or peritoneal metastases is related to the median overall survival of advanced gastric cancer.Therefore,it is important to develop effective treatments for ascites and peritoneal metastases.Apatinib mesylate,also known as Livocumab,is a new type of small molecule selective vascular endothelial growth factor receptor 2 tyrosine kinase inhibitor and is the second anti-vascular Generate drugs.Approved in China for advanced or metastatic gastric cancer.It is used in advanced gastric adenocarcinoma(including gastroesophageal adenocarcinoma(GEA)or other advanced cancers with experience in chemotherapy,such as non-small cell lung cancer(NSCLC),breast cancer,gynecological cancer,hepatocellular carcinoma(HCC),thyroid cancer and sarcoma.Compared with placebo,as a third-line or follow-up treatment,oral apatinib mesylate significantly prolonged median progression-free survival(PFS)and overall survival(OS),and had advanced or metastatic disease in China Gastric cancer or GEA randomly grouped patients,safety-controllable,double-blind,multicenter,phase 2 and phase 3 trials.More limited evidence also supports their use as patients with other advanced or metastatic solid tumors(including NSCLC,breast cancer,and HCC)follow-up treatment for Chinese patients.Further clinical experience and long-term pharmacovigilance data are needed to more accurately determine the efficacy and safety of apatinib,including in combination with other drugs.Tiglio is a new generation of fluorouracil oral preparations,consisting of tegafur,gemetasin,and otiracil potassium.However,there are few reports on the use of apatinib combined with chemotherapy in the treatment of advanced gastric cancer with cancerous ascites.This study investigated the efficacy and toxic side effects of apatinib combined with chemotherapy for patients with gastric cancer associated with refractory cancerous ascites.ObjectiveIn this study,48 patients with gastric cancer accompanied by refractory ascites were treated with apatinib mesylate.combined with chemotherapy to observe its efficacy and toxic side effects.MethodsWe collected patients with advanced gastric cancer and refractory cancerous ascites admitted to the Second Affiliated Hospital of Zhengzhou University from March 2017 to March 2019,the inclusion criteria were as follows:(1)Patients were diagnosed by imaging,histopathology,or cytology.Patients with advanced gastric cancer with refractory cancerous ascites;(2)Estimated survival time is 3 months and above;(3)ECOG score is 0-2 points;(4)No contraindication to chemotherapy;(5)The primary tumor and metastases can be measured.Exclusion criteria:(1)Patients with contraindications to chemotherapy,targeted therapy,and target lesion radiotherapy;(2)With severe heart,liver,kidney,and other organ dysfunction;obvious bleeding tendency;severe hypertension;(3)Apatinib contraindications;(5)Those with inadequate absorption or inability to take drugs orally;(6)Patients with a history of mental illness who have difficulty cooperating effectively with treatment and follow-up;Participating in other drug trials.A total of 48 patients were enrolled in the study.They were divided into two groups using the random number table method,which were the combination treatment group and the basic treatment group,with 24 cases each.The patients in the combination treatment group were treated withapatinib mesylate on the chemotherapy regimen in the basic treatment group,and the patients in the basic treatment group were treated with oxaliplatin+tigiob.If apatinib treatment is discontinued for any reason,the date of the last dose and the main reason for discontinuation should be recorded and the patient withdrawn from the study.ResultAmong the 48 patients included,There was no statistically significant difference in baseline gender,average age,surgical status and degree of differentiation between the two randomised patients.The efficacy of the combined treatment group was better than that of the basic treatment group.There was statistical significance(P=0.013<0.05).The depth of ascites in the combined treatment group was lower than that in the basic treatment group(P=0.004<0.05),but the differences in ascites control time and drainage frequency were not significant(P<0.05).Adverse reactions in patients in the two groups included hypertension,hand-foot syndrome,liver dysfunction,proteinuria,renal dysfunction,diarrhea,and vomiting,most of which were 0 to II degrees,which could be basically controlled after treatment,and the patients were well tolerated.The incidence of adverse reactions was compared between the two groups.The differences in hypertension,hand-foot syndrome,proteinuria,and vomiting were statistically significant(P>0.05).The differences in liver and kidney dysfunction and diarrhea were not statistically significant(P>0.05).ConclusionCompared with the basic treatment group of oxaliplatin+tigio,the combination treatment group of apatinib mesylate and oxaliplatin+tigio is better in patients with advanced gastric cancer and refractory cancerous ascites Among them,hypertension,proteinuria,hand-foot syndrome and vomiting had higher adverse reactions.