Clinical Observation Of Apatinib Combined With GP Regimen In The Treatment Of Recurrent Or Metastatic Nasopharyngeal Carcinoma

Objective:Nasopharyngeal carcinoma(NPC)is a malignant tumor originating from the epithelium of nasopharyngeal mucosa.World Health Organization(WHO)International Agency for Research Cancer IARC)showed that in 2012,new nasopharyngeal carcinoma(NPC)in China accounted for about 38%of new NPC cases worldwide.With the aging of the population and the development of society,the incidence of NPC increased every year.In 2014,the number of new NPC cases in China was about 44,600(male about 31,600 cases,female about 13,000 cases),accounting for 1.17%of all malignant tumors,ranking the 20th highest in the incidence of malignant tumors.The incidence of NPC in China is mainly concentrated in five southern provinces(Guangdong,Guangxi,Hunan,Fujian and Jiangxi),of which Guangdong Province has the highest incidence.The etiology of nasopharyngeal carcinoma(NPC)is still unclear.At present,more definite pathogenic factors include genetic susceptibility,EB virus infection and other environmental risk factors,such as eating high-content nitrite food,smoking,drinking,chemical gases and having received radiation.Because of the complex anatomy of the nasopharynx and the atypical early clinical symptoms of nasopharyngeal carcinoma,about 60%-70%of patients had skull base destruction at the time of consultation,18%of patients had intracranial or cavernous sinus invasion,and about 85%of patients had cervical and/or retropharyngeal lymph node metastasis,thus losing the plan of surgery.Nasopharyngeal tumors are mainly poorly differentiated/undifferentiated carcinomas and are sensitive to radiotherapy.Therefore,radiotherapy is the main treatment for nasopharyngeal carcinoma.With the development of radiotherapy technology in recent years,the 5-year survival rate of nasopharyngeal carcinoma patients after radiotherapy can reach 80%,but distant metastasis and local recurrence are still the main factors of treatment failure.For recurrent or distant metastatic nasopharyngeal carcinoma becomes the main cause of treatment failure.Recurrent nasopharyngeal carcinoma after treatment has reduced sensitivity to radiotherapy and chemotherapy,and the treatment effect is poor.At present,there is no definite treatment for recurrent nasopharyngeal carcinoma.Therefore,exploring treatment options for recurrent or metastatic nasopharyngeal carcinoma remains an important topic of treatment.This study provides a clinical basis for the treatment of recurrent or metastatic nasopharyngeal carcinoma by comparing the short-term efficacy and adverse reactions of apatinib combined with GP regimen and GP regimen alone in the treatment of recurrent or metastatic nasopharyngeal carcinoma.Methods:A retrospective analysis was made of 38 patients with recurrent or metastatic nasopharyngeal carcinoma who were treated in the Department of radiotherapy,the First Affiliated Hospital of Zhengzhou University from December 2017 to December 2018.According to their different treatment methods,they were divided into treatment group and control group.Among them,the treatment group was treated with apatinib combined with GP regimen chemotherapy,while the control group was treated with GP regimen chemotherapy alone.All patients completed 2 cycles of treatment.After treatment,the patients in the two groups were observed Short term efficacy and adverse reactions.Results:After treatment,the efficacy of two groups of patients was evaluated.The objective remission rate of the treatment group was 59.1%,and the disease control rate was 81%.The objective remission rate of the control group was 25.0%,and the disease control rate was 75.0%.There was a significant difference in the objective remission rate between the two groups(P<0.05).The median progression-free survival time(mPFS)of the treatment group and the control group were 7.3 months and 4.8 months,respectively,and the difference was statistically significant(P=0.01<0.05).There were no significant adverse reactions during treatment in both groups.Conclusions:Compared with GP chemotherapy alone,apatinib combined with GP regimen in the treatment of recurrent or metastatic nasopharyngeal carcinoma can improve the objective response rate and prolong the progression-free survival without increasing adverse reactions.It is worth further clinical study.