| Objective:Esophageal cancer is one of the most common malignancies in China,with a poor prognosis.According to relevant reports,in 2012,there were about 455,000 cases of new esophageal cancer worldwide,among which 277,000 cases were found in China,with a death toll of 206,000.Surgery is the preferred method for esophageal cancer,but the long-term effect is not ideal,postoperative local recurrence and lymph node metastasis are the main reasons for the failure of surgical treatment.Chemotherapy is one of the main treatment methods for advanced esophageal cancer or postoperative recurrence of esophageal cancer.Currently,most advanced esophageal cancer is treated with platinum or fluorouracil chemotherapy as the first-line standard chemotherapy,with an effective rate of about 40%.For advanced esophageal cancer after the failure of first-line chemotherapy,currently,most of them are single drug or combination drug regimens based on taxanes such as paclitaxel,docetaxel,irinotecan,etc.,but the effective rate is only 15-25%.Therefore,in order to find more effective second-line or third-line treatment,it has become an urgent social need and a difficult problem for medical tumor research.Molecular targeted therapy ACTS on specific tumor targets,mainly by inhibiting or interfering with the specific targeted molecules needed for tumor development and growth to prevent the proliferation and migration of cancer cells,etc.It has the advantages of strong specificity and little side effects,and has become an effective means for the treatment of advanced esophageal cancer.At present,the molecular targeted therapy of esophageal cancer,part II/III period clinical trial study,such as for epidermal growth factor receptor(EGFR)and human epidermal growth factor receptor 2(Her-2),vascular endothelial growth factor(VEGF),c-mesenchymal-epidermal transition factor(c-MET)as well as targeted therapymade some achievements.Apatinib is a small-molecule vascular endothelial cell growth factor receptor-2(VEGFR-2)tyrosine inhibitor,which can selectively compete for the ATP binding site of VEGFR-2 in cells,inhibit angiogenesis in tumor tissues,and achieve anti-tumor effect.In October 2014,it was approved to be marketed in China for the treatment of advanced gastric adenocarcinoma or gastroesophageal junction adenocarcinoma with recurrence or progression after two or more systemic chemotherapy.In addition,a number of clinical studies have reported satisfactory clinical efficacy of apatinib in the treatment of colon cancer,non-small cell lung cancer,liver cancer,breast cancer and other malignant tumors.The purpose of this study was to compare and analyze the clinical efficacy,safety and effect on serum tumor markers of recurrent or distant esophageal cancer after chemotherapy with apatinib and TP regimen,so as to provide references for further clinical application.Methods:Retrospective analysis was performed on 60 patients with recurrent or metastatic esophageal cancer admitted by the First Affiliated Hospital of Zhengzhou University from October 2016 to January 2018.All patients had relapsed after receiving first-line or second-line chemotherapy.According to different treatment regimens,the patients were divided into observation group and control group,each with 30 cases.Control group received docetaxel plus cisplatin chemotherapy regimen:the total amount of docetaxel 60?75mg/m2,d1;the total amount of Cisplatin 75mg/m2,once a day,divided into 3 days.The observation group received apatinib combined with docetaxel plus cisplatin regimen:500mg apatinib/time,oral administration half an hour after meal,once a day;The dosage and dosage of docetaxel and cisplatin were the same as the observation group.21 days was one treatment cycle,and both groups were treated for more than 4 consecutive cycles.Objective remission rate,local control rate,median progression-free survival,incidence of adverse reactions and serum tumor markers were compared between the two groups.Results:1.The diseasec control rate of the observation group was 86.7%(26/30),significantly higher than that of the control group(60%(18/30),with statistically significant difference(P<0.05).The objective response rate of the observation group was 33.3%(10/30),slightly higher than that of the control group(20%(6/30),but the difference was not statistically significant(P>0.05).The median progression-free survival in the observation group and the control group was 5.0 months(95%CI:4.1-5.9)and 3.8 months(95%CI:3.1-4.5),respectively.There was no statistically significant difference between the two groups(P>0.05).2.In the non-blood adverse reactions,hypertension,hand-foot syndrome(HFSR)and proteinuria in the observation group were higher than those in the control group,with statistically significant differences(P<0.05),and there was no statistically significant difference in nausea and vomiting symptoms between the observation group and the control group(P>0.05).Among the adverse blood reactions,there was no statistically significant difference between the observation group and the control group in leukopenia,haemoglobin reduction and thrombocytopenia(P>0.05).The adverse reactions were mainly grade ???,which could be alleviated after symptomatic treatment.3.After treatment,the CEA and CYFRA21-1 levels of the observation group and the control group were lower than those before treatment,and the reduction level of the observation group was significantly higher than that of the control group,with statistically significant differences(P<0.05).Conclusions:Compared with TP chemotherapy regimens alone,apatinib combined with TP chemotherapy regimens in the treatment of recurrent or metastatic esophageal cancer,although it did not reduce the objective remission rate and improve mPFS,it could significantly improve the disease control rate,reduce serum CEA and CYERA21-1 levels,with controllable adverse reactions and high safety. |
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