Comparison Of The Therapeutic Efficacy Of Immune Checkpoint Inhibitors Or Apatinib Combined With Chemotherapy For Maintenance Treatment Of Advanced Gastric Cancer

Objective:Patients with advanced gastric cancer who have stable disease assessment after first-line treatment enter maintenance therapy.The purpose of this study is to compare the efficacy and safety of immune checkpoint inhibitors(ICIs)or apatinib combined with capecitabine or S-1(combination therapy group)versus capecitabine or S-1alone(control group)in maintenance therapy.Methods:A retrospective analysis was conducted on clinical data of patients who received first-line treatment for advanced gastric cancer and entered maintenance therapy at the Second Affiliated Hospital of Nanchang University from September 2020 to December 2022.The patients were divided into the combination therapy group and the control group based on the different maintenance therapy regimens.The efficacy and safety of the two groups were analyzed and compared.Statistical analysis was performed using SPSS 25.0 software,and a difference with P<0.05 was considered statistically significant.Results:A total of 50 eligible patients were included,with 30 in the combination therapy group and 20 in the control group.The median progression-free survival(PFS)and overall survival(OS)in the combination therapy group were higher than those in the control group(13.3 months vs.12.6 months,P=0.039;17.7 months vs.16.9 months,P=0.033),and the differences were statistically significant.The objective response rate(ORR)was 6.7% vs.10% and the disease control rate(DCR)was 70% vs.60%for the combination therapy group and the control group,respectively,with no statistically significant differences(P>0.05).Cox multivariate regression analysis revealed that PS score of 2,multi-organ metastasis,monotherapy maintenance treatment,and high neutrophil-to-lymphocyte ratio(NLR)were independent risk factors for median PFS(HR=3.581,95% CI: 1.589-8.071,P=0.002;HR=2.052,95%CI: 1.053-3.996,P=0.035;HR=2.007,95% CI: 1.014-3.972,P=0.045;HR=3.463,95% CI: 1.342-8.932,P=0.010).There was no statistically significant difference in adverse drug reactions between the two groups.Conclusions:In maintenance therapy for advanced gastric cancer,ICIs or apatinib combined with chemotherapy showed better efficacy compared to chemotherapy alone,with overall manageable adverse reactions.