| Background and purpose Lung cancer is one of the most highly malignant cancers in the world.It is also the leading cause of cancer death among men and the second leading cause of cancer death(after breast cancer)among women worldwide.The latest data show that,730 thousand people were diagnosed with lung cancer and 610 thousand people died of it last year,accounting for 17.1% and 21.7% of all malignant tumors,respectively.Most patients were in end-stage when diagnosed of lung cancer,and more than half of them died in one year,five years survival rate is less than 18%.At present,the usual methods of treatments of lung cancer are surgery,chemotherapy,radiotherapy and immunotherapy.However,these treatments can only alleviate the disease to some extent.If the tumor relapses or progresses,there will be no more effective drugs.Gefitinib,erlotinib and crizotinib are targeted drugs that only used for patients with positive gene mutations,which results in limited application in clinic.Apatinib is a small molecule inhibitor of vascular endothelial growth factor receptor-2 that can inhibits tumor angiogenesis.It has demonstrated encouraging anti-tumor effect in some clinical trials which m PFS and m OS were 3.67 months and 4.83 months,respectively.Because of this,it was approved and launched by Chinese FDA in October 2014 as a subsequent-line treatment for patients with advanced gastric adenocarcinoma and gastric-esophageal junction adenocarcinoma after failing in the second line or beyond treatment.At present,the research of apatinib is mainly focused on gastric cancer,but few in lung cancer,breast cancer,cholangiocarcinoma and colorectal cancer.This study was designed to investigate the clinical efficacy and safety of apatinib in advanced lung cancer.Meterials and Methods We collected 39 cases that were histologically and cytologically diagnosed with lung cancer at stage IIIA~IV and failed in second-line or beyond treatment from January 2015 to March 2017 at the First Affiliated Hospital of Zhengzhou University.Apatinib was administered 425 mg daily in each 28-day cycle until progression or intolerable adverse reactions happened.Clinical efficacy and adverse reactions were observed.Statistical Methods The study used SPSS 17.0 software for statistical analysis.Kaplan-Meier method was used for survival analysis.Log-rank test was used to screen the factors influencing the prognosis and Cox proportional hazard model for the multivariate analysis was used to further confirm the independent factors.P < 0.05 was considered statistically significant difference.Results 1.Survival analysis: 39 patients with advanced lung cancer were enrolled with a median age of 62 years(range from 33 to 75 years old)and all of them were eligible for efficacy analysis.Median PFS was 3.5 months and median OS was 5.1 months.CR was 0%(0/39),PR was 2.6%(1/39),SD was 58.9%(23/39)and PD was 38.5%(15/39).ORR and DCR were 2.6% and 61.5%,respectively.2.Adverse reactions: The main adverse reactions were hypertension(35.9%),proteinuria(25.6%),hand-foot syndrome(25.6%),diarrhea(20.5%)and bone marrow suppression(38.5%).All of them got relief after positive treatment.3.Univariate analysis: differentiation degree,ECOG score,adverse reactions degree were prognostic factors.Patients with well-differentiated,ECOG score of 0 to 1,mild adverse reactions have a better prognosis.Sex,age,pathological type,tumor size were not related to prognosis.4.Multivariate analysis: differentiation degree,ECOG score,adverse reactions degree were the independent factors of apatinib for the advanced lung cancer.Conclusion Apatinib still demonstrated encouraging clinical efficacy in advanced lung cancer after failing in second-line or beyond treatment and adverse reactions were manageable after positive treatment.Patients with well-differentiated,good KPS and mild adverse reactions had a better prognosis. |
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