The Analysis Of Clinical Efficacy And Safety Of Apatinib In The Treatment Of Advanced Head And Neck Tumor

Background and Objective The head and neck tumor is the sixth most common malignant tumor,accounting for about 5% of all tumors,which refers to the anatomic region of the front of the cervical spine,from skull to clavicle.The neck and neck tumor mainly includes: oral cancer,laryngeal cancer,and nasopharyngeal cancer,paranasal sinus cancer,hypopharyngeal cancer,salivary gland tumor,and neck tumor such as thyroid tumor.The main pathological type of head and neck tumor is squamous cell carcinoma,accounting for about 90% of all head and tumors.Head and neck cancer is the 8th leading cause of death associated with cancer.The overall incidence of head and neck tumor is increasing year by year.This trend is particularly evident among young women,but generally speaking,the incidence of men is still higher than that of women.Early symptoms of head and neck tumor are often not obvious,so most patients are already at advanced stage(stage III or IV)when diagnosed.The pathogenesis of head and neck tumor is multifactorial,with a variety of risk factors,including gender,age,heredity,ethnicity,susceptibility of the organism,region,etc.The risk factors also cover three general cancer factors: chemical,physical,and biological carcinogenic factors.Human papillomavirus(HPV)is known to be associated with the occurrence of oropharyngeal cancer,and EB virus is associated with the occurrence of nasopharyngeal carcinoma.At present,the treatment of early stage patients is surgery or radiotherapy alone.Patients of locally advanced and recurrent or metastastic stage are mainly treated with comprehensive therapy.Nasopharyngeal cancer is mainly treated with radiotherapy and chemotherapy.The structure of the head and neck is complex,and the space around the tumor is narrow,tumors are often in the deep tissue,with a blurred outline to adjacent structure,so the tumor itself and the treatment may cause damage to the surrounding organs.Although with the rapid development of modern medicine,the treatment of many cancers has made significant progress,but the treatment of head and neck tumors is still not satisfactory.In recent years,the targeted treatment of tumors is becoming more and more popular with researchers.anti-angiogenic drug is one of the most prevailing.Angiogenesis plays an important role in the development of tumors,and the VEGF-VEGFR signaling pathway plays an important role in angiogenesis.VEGFs combine with the extracellular domain of VEGFR exclusively,activating multiple downstream pathways.promoting the formation of blood vessel.VEGFR-2 plays an important role in angiogenesis in the VEGFR family,VEGFs can cause the proliferation of endothelial cells by binding to VEGFR-2.For example,apatinib can block the activation of VEGFR-2,and the proliferation of endothelial cells decrease.In this way,tumor angiogenesis is inhibited.At present,anti-angiogenic therapy has made significant progress in the treatment of many cancers in clinical practice,such as apatinib for the treatment of gastric cancer,colorectal cancer,lung cancer,etc.But research on anti-angiogenic therapy of head and neck tumor is rare.The purpose of the study is to observe the clinical efficacy(ORR?DCR?PFS)and safety of apatinib in the treatment of advanced head and neck tumor and provides a reference for clinical treatment.Methods A total of 84 patients with advanced head and neck tumor treated in our hospital from 2015.9-2017.4 were selected as the study objects.By analyzing the clinical data of these patients retrospectively,84 patients were divided into 2 groups, with 42 cases each group.Patients of control group were treated with the PF(21 cases)and TPF(21 cases)chemotherapy while patients of treatment group were given Apatinib on the basis of control group's treatment at the same time(PF+Apatinib 21 cases,TPF +Apatinib 21 cases).Patients' disease control situation,PFS and drug safety is recorded by follow-up.Statistical methods This study uses SPSS21.0 for statistical analysis of all data.The normal measurement data was expressed as ?x±s,The t-test was used to compare the data between the two groups;the count data was expressed as the rate[ n(%)],and the comparison between the two groups was performed by the ?2 test.The survival curve was plotted by the Kaplan-Meier method.Log-Rank test was used to compare survival curves between two groups.P<0.05 was considered as statistically significant.Results 1.The disease control rate(83.3%,35 cases)of treatment group was higher than that of control group(61.9%,26 cases)(P < 0.05).The objective response rates of treatment group(33.3%,14 cases)and control group(23.8%,10 cases)were not significantly different.2.The median PFS of treatment group and control group were 11.4 months(95% CI: 10.1-12.7)and 9.6 months(95% CI: 7.2-12.0).The survival curve of the PFS of two groups,when tested by Log-Rank,were significantly different(c?2=4.335,P=0.037).3.The incidence of hypertension in the treatment group and the control group were 33.3%(14 cases)and 14.3%(6 cases)respectively.The incidence of proteinuria in the treatment group and the control group were 31.0%(13 cases)and 11.9%(5 cases)respectively.the difference was statistically significant(P < 0.05),and the incidence of other adverse events such as neutropenia,thrombocytopenia,nausea and vomiting,hand-foot syndrome, abdominal pain and diarrhea,fatigue,decrease of appetite,stomatitis,hypoalbuminemia,anemia,hoarseness,bleeding,rash,headache of two groups are not significantly different(P>0.05).Conclusion The addition of Apatinib in the treatment of head and neck tumor has a better control of disease and survival benefit and its adverse events are tolerant.