Meta-analysis Of The Efficacy And Safety Of Apatinib In Combination With Chemotherapy For Advanced Gastric Cancer

Objective: gastric cancer is the common tumor,which is highly malignant,Most of the patients were found to be advanced,the targeted therapy has opened up new world for advanced gastric cancer.In this study,To systematically evaluate the safety and efficacy of apatinib combined with chemotherapy for patients with advanced gastric cancer.Methods: We used to search SCI,Pub Med,CNKI,Springer,Wan Fang Data,China Biomedical Literature Database,VIP from January 2014 to December 2017,the experimental group was treated with apatinib in combination chemotherapy,the control group was chemotherapy alone,to collect randomized controlled trials(RCTs)or non-RCTs about advanced gastric cancer.Reviewers firstly screened studies,extracted data and assessed the risk of bias of the included studies.Then meta-analysis was conducted by using Rev Man 5.3 software,and simultaneously the GRADE System was performed to rate the strength of evidence.results: Eleven studies were included involving 733 advanced gastric,of which eight were RCTs and the other three were non-RCTs.In terms of effectiveness,meta-analysis results showed that the trial group was superior to the control group in objective response rate(OR=2.42,95%CI 1.75 to 3.34,P<0.00001)and disease control rate(OR=3.08,95%CI 2.02 to 4.70,P<0.00001).The efficacy of apatinib combined with chemotherapy is better than that of chemotherapy alone,and the best dose of apatinib combined with chemotherapy is 250mg(OR250mg=4.47>OR500mg >OR850mg).In terms of safety,the incidence of leukopenia(OR=2.11,95%CI 1.34 to 3.32,P=0.001)and hypertension(OR=4.91,95%CI 1.54 to 15.68,P=0.007)in the trial group were higher than the control group,While there was no significant difference in the incidence of hand-foot syndrome and gastrointestinal reaction.Based on GRADE,the level of the recommended evidence for gastrointestinal reaction and hand-foot syndrome was moderate(Grade B),The others was lower(Grade C).conclusion: Compared with chemotherapy alone,apatinib combined with chemotherapy in the treatment of advanced gastric cancer can significantly improve response rate,but it may increase the incidence of leukopenia and hypertension.