Clinical Efficacy And Prognosis Of Apatinib In The Treatment Of Advanced Small Cell Lung Cancer

Background and ObjectivesLung cancer is currently one of the highest incidence of malignant tumors in China,accounting for the highest mortality of malignant tumors.Among them,about 15% is small cell lung cancer,which is closely related to the history of smoking and mostly male.With the acceleration of industrialization,the aggravation of population aging,and the increase of environmental pollution in recent years,the cancer burden on lung cancer in our country has become increasingly severe and the incidence has increased year by year.Small cell lung cancer is a highly malignant neuroendocrine tumor with strong invasiveness and poor prognosis.At present,the treatment of small cell lung cancer is progressing slowly.The commonly used clinical treatments are chemotherapy,radiotherapy,and immunotherapy.Due to the limited treatment options,the majority of patients in the second or third line of chemotherapy failed to be in the drug-free environment.Apatinib is a new type of oral small molecule anti-angiogenic drug.Although Apatinib's clinically approved indication is mainly gastric cancer,but it has been used as a multi-target anti-angiogenic drug in recent years.Many attempts have been made in the treatment of solid tumors such as breast cancer,liver cancer,and non-small cell lung cancer,some significant results have also been achieved.As far as the treatment of small cell lung cancer is concerned,there are few attempts in this area in clinical practice.In this study,35 patients with small cell lung cancer diagnosed in the past three years were studied.The purpose of this study is to investigate the efficacy of Apatinib in the treatment of small cell lung cancer,and to analysis the factors affecting the prognosis.Materials and MethodsThis study collected 35 cases of patients from the First Affiliated Hospital of Zhengzhou University with small cell lung cancer who had undergone biopsy and pathology admitted to from January 2014 to August 2017,including 30 males and 5 females.There were 14 patients who had relapsed after treatment in the limited period and 21 patients in the extensive period.All patients were given oral Apatinib 425mg-625mg/day,of which 4 patients were treated with oral Apatinib 425mg/day,and 30 patients were treated with oral Apatinib 500mg/day.1 case of patient received oral Apatinib 675 mg/day.All patients were treated with drugs until the disease progressed or intolerable adverse reactions were observed.Record the results of imaging efficacy evaluation after taking apatinib and adverse reactions during medication Statistical methodsIn this study,SPSS20.0 statistical software were used for 35 cases of SCLC patients with gender,age,Ki-67% expression level,stage,treatment,start time of oral apatinib treatment,distant metastasis,ECOG score,smoking history,a data analysis of therapeutic efficacy evaluation,adverse reactions and severity of treatment during the treatment of apatinib.Kaplan-Meier method were used for the estimation of PFS and OS in patients with SCLC treated with apatinib and univariate analysis.And then,use Log-Rank test if the univariate analysis had statistically significant differences in the influencing factors.Cox regression models were used for multiple factors to determine the independent prognostic factors affecting the efficacy of apatinib in the treatment of SCLC.Results 1.The analysis of efficacy: 35 patients with advanced small cell lung cancer were enrolled in this study.according to the RECIST1.1 criteria,0 of Complete Response(CR)was achieved,5 cases of Partial Response(PR)accounted for 14.3%(5/35),and 20 cases of Stable disease(SD)accounted for 57.1%(20/35).There were 10 cases of Progressive Disease(PD),accounting for 18.6%(10/35).The Objective Response Rate(ORR)(CR+PR)was 14.3%,and the Disease Control Rate DCR(CR+PR+SD)was 71.4%.Median Progressive Free Survival(mPFS)was 3.3 months,and the median overall survival(mOS)was 4.9 months.2.Adverse reactions: Mainly include hypertension(31.4%),hemorrhage(8.6%),proteinuria(34.3%),elevated transaminase(11.4%),hand-foot syndrome(28.6%),diarrhea(8.6%),bone marrow suppression(31.4%),oral ulcers(11.4%),fatigue(14.3%).The adverse reactions in most patients were I-II degree,and symptoms were relieved after symptomatic treatment.In 2 patients,the drug was reduced to 250 mg/day due to adverse reactions,and another patient was discontinued due to severe hemoptysis.3.The results of univariate analysis: The ECOG score,the severity of adverse reactions induced by Apatinib were related to the prognosis of Apatinib,and the patients with ECOG score of 0 to 1,mild adverse reactions have a better prognosis,while the expression level of Ki-67,sex,age,brain metastasis,liver metastasis or smoking history have nothing to do with the prognosis of patients treated with Apatinib.4.The results of multivariate analysis: The ECOG score and the severity of adverse reactions caused by taking Apatinib were independent factors in the treatment of SCLC.Among them,ECOG score of 0 to 1,and mild adverse reactions after taking Apatinib have a better prognosis.Conclusions1.Apatinib can be used in patients with advanced small cell lung cancer after failing in first line or beyond treatment,and has a certain clinical benefit.The adverse reactions can be controlled,and it is worth trying in clinic.2.Patients with a score of 0-1 on the ECOG score and mild adverse reaction after Apatinib had a better prognosis.