Therapeutic Effect Of Apatinib Combined With Second Or Third-line Single Drug Chemotherapy On SCLC And Its Effect On Serum Level Of VEGF

Objectives: The incidence of small cell lung cancer(SCLC)accounts for 15-20% of the new lung cancer patients,which is highly invasive,malignant and prone to distant metastasis.The first-line treatment of SCLC is sensitive,but most patients will be resistant to chemotherapy after relapse.The objective remission rate of second-line and third-line treatment is generally less than 25%.The median survival time of patients with recurrence and metastasis is only 4-5 months.Apatinib is an oral small molecule anti-angiogenic tyrosine kinase inhibitor,which inhibits the activity of VEGFR-2 tyrosine kinase,inhibits neovascularization,and thus inhibits the growth and metastasis of tumors.In recent years,individual reports on the treatment of recurrent and metastatic SCLC with Apatinib have shown some efficacy.On this basis,we discussed the efficacy and safety of apatinib combined with chemotherapy in the second or third line treatment of SCLC and its effect on serum level of VEGF.Methods: From January 2017 to February 2019,86 patients with SCLC relapsed and metastasized after first-line or second-line treatment were included in this study.They were randomly divided into observation group and control group.Among them,the observation group was treated with apatinib combined with single-drug chemotherapy,while the control group was treated with single-drug chemotherapy.The patients' gender,age,ECOG score,staging,recurrence and metastasis,whether pleural effusion and hyponatremia were combined,adverse reactions,treatment and efficacy,and the level of serum VEGF expression before and after treatment were recorded in detail.The curative effect was evaluated by RECIST 1.1 criteria for evaluating the curative effect of solid tumors.SPSS17.0 statistical software was used for data analysis.Results: 86 patients were enrolled in the study.82 patients could evaluate the efficacy.Evaluate according to RECIST 1.1 evaluation criteria.As of February 15,2020,one patient had survived.The ORR,DCR,PFS and OS of the observation group were 25.00%,87.50%,3.50 and 6.80 months respectively,while those of the control group were 19.05%,83.33%,3.50 and 6.30 months respectively.There was no significant difference in the median PFS between the two groups(P=0.22),and the median OS was close to the difference(P=0.08).Subgroup analysis showed that patients younger than 65 years old(P = 0.056)or with ECOG score of 0-1(P = 0.053)might benefit from OS.Univariate analysis and multivariate analysis showed that the degree of adverse reactions was an independent prognostic factor of second-line or third-line chemotherapy combined with apatinib for SCLC.Serum VEGF was highly expressed in patients with SCLC.After treatment,the serum VEGF level was significantly reduced.There was no significant difference between the two groups before and after treatment.Subgroup analysis showed that the level of VEGF in CR + PR group was significantly lower than that in SD + PD group.The incidence of hypertension(15.00% vs 0.00%)and proteinuria(7.50% vs 2.38%)in the observation group were significantly higher than those in the control group.No new adverse reactions were found.Conclusion:1.Apatinib combined with single drug chemotherapy is effective and acceptable in second or third line treatment of SCLC.Patients younger than 65 years old with ECOG score of 0-1 may benefit from apatinib combined with single drug chemotherapy.2.The expression level of serum VEGF in SCLC patients was significantly increased.The expression level of serum VEGF was correlated with the curative effect after treatment.3.The degree of adverse reactions is an independent prognostic factor for the second or third-line treatment of SCLC with apatinib combined with single drug chemotherapy.