Efficacy Of Apatinib Combined With S-1 In The Treatment Of Advanced Gastric Cancer

Background: In recent years,The chemotherapy and targeted therapies of advanced gastric cancer(GC)have made great improvement.The aim of this study was to investigate the efficacy and safety of anti-angiogenic drug(apatinib)in combination with fluorouracil-based drugs(S-1)for the treatment of advanced gastric cancer.Materials and methods: During the period from October 2015 to October 2016,48 patients with advanced gastric cancer who were confirmed by pathology after chemotherapy failure or metastasis were collected from Department of Oncology,Central Hospital of Dalian,The curative effect and safety of apatinib combined with S-1 regimen(24 cases)and single drug S-1 regimen(24 cases)were retrospectively analyzed.The main reference standards are solid tumor efficacy evaluation criteria: RESIST 1.1 and the United States National Cancer Center Common Toxicity Standard(CTCAE),version 4.0,The curative effect is divided into complete remission(CR),partial remission(PR),stable disease(SD),lesion progression(PD).The efficacy indicators involved were objective response rate(ORR),disease control rate(DCR),progression-free survival(PFS).ORR is the proportion of patients with CR + PR,DCR is the proportion of patients with CR + PR + SD,the safety index is classified as adverse reaction;And make a single factor survival analysis that affects PFS.Clinical information is obtained by referring to the medical record and follow-up.All the results were analyzed by SPSS24.0 software,t test was used to measure the data,chi-square test was used to count data,and Kaplan-Meier analysis was used to predict the single factor survival.P <0.05 was considered statistically significant.Result: 1.ORR: Apatinib+ s-1 group: CR: 0 cases,PR:2 cases;S-1 group: CR:0 cases,PR:0 cases,the ratio of the two groups was 8.3% and 0%,P=0.47,the difference was not statistically significant.2.DCR: Apatinib+ s-1 group: CR: 0 cases,PR:2 cases,SD:15 cases;S-1 group: CR:0 cases,PR:0 cases,SD: 9 cases,the ratio of the two groups was 70.8% and 37.5%,P=0.02,the difference was statistically significant.3.PFS :The median PFS of Apatinib + S-1 group and S-1 group were 123 d and 79 d,respectively.The former significantly prolonged the median PFS of patients with advanced gastric cancer(P = 0.041),the difference was statistically significant.4.Hematologic toxicity: Leukopenia,hemoglobin,and thrombocytopenia at I-IV were 33.3% and 50.0%,20.8% and 33.3%,12.5% And 25.0%,respectively in the apatinib + S-1 group and the S-1 group,P were 0.242,0.330,0.460,the difference was not statistically significant;Non-hematologic toxicity: nausea and vomiting,diarrhea and stomatitis accounted for 29.2% and 50.0%,33.3% and 58.3%,12.5% and 33.3% respectively in the apatinib + S-1 group and the S-1 group,P were 0.140,0.082,0.057,the difference was not statistically significant;Hypertension,proteinuria and hand-foot syndrome accounted for 4.2% and 45.8%,0% and 25.0%,12.5% and 41.7% respectively in the apatinib + S-1 group and the S-1 group,P were 0.001,0.020,0.023,the difference was statistically significant.5.All patients affected PFS univariate survival analysis: in the age of <65 years old and ? 65 years old,the transfer of 1 and ? 1,the resection was resected and not removed,the primary tumor site in the antrum,junction,body of the stomach,in the Chemotherapy after second-line chemotherapy and second-line chemotherapy before,The P values of univariate survival analysis of PFS were 0.822,0.935,0.692,0.156,respectively.the difference was not statistically significant;in NLR <3.41 and ? 3.41 P =0.014,the difference was statistically significant.6.The effect of apatinib + S-1 group on PFS single-factor survival analysis:1): Age 65 years and 65 years old,metastasis 1 and ? 1,the tumor has been removed and not removed,the tumor site in the antrum,junction,gastric body,after second-line chemotherapy and second-line chemotherapy before the two groups The P values of univariate survival analysis of PFS were 0.580,0.845,0.281,0.472,0.425,respectively,with no significant difference.2): Hematological toxicity: Leukopenia or not,hemoglobin decreased or not,thrombocytopenia or not affect the PFS single-factor survival analysis P values were 0.374,0.732,0.395,the difference was not statistically significant;3): Non-hematologic toxicity: Nausea and vomiting occurred or not,or not diarrhea,stomatitis or not,hypertension or not PFS single factor affecting survival analysis 0.942,0.218,0.340,0.154 P values were not statistically significant;Proteinuria occurred or not,hand-foot syndrome or not affect the PFS single factor survival analysis P values were 0.024,0.042,the difference was statistically significant.Conclusions: For the treatment of advanced gastric cancer: 1.The group of apatinib + S-1 showed no obvious advantage in ORR,but superior to single-drug S-1 in DCR.2.Apatinib combined with S-1 have a survival advantage than S-1 in median PFS.3.The group of apatinib + S-1 showed no significant increase in hematology,nausea,vomiting,diarrhea and stomatitis compared with single S-1 group,but higher in hypertension,proteinuria and hand-foot syndrome than single S-1 group.4.The age,metastasis,resection,primary tumor site,and chemotherapy of all patients were not predictors of PFS.NLR <3.41 prolonged PFS,and NLR ? 3.41 decreased PFS as predictive factors.5.The age,metastasis,resection,primary tumor site,chemotherapy,hematologic toxicity,nausea and vomiting toxicity,diarrhea toxicity,stomatitis toxicity and hypertensive toxicity were not the predictors of PFS in the apatinib + S-1 group.Uremia,hand-foot syndrome toxicity is a predictor.