A Retrospective Study Of Apatinib Combined With Chemotherapy Versus Chemotherapy Alone In Residual Or Recurrent Gliomas

Objective:To compare the clinical efficacy and safety of apatinib combined with chemotherapy and chemotherapy alone in the treatment of residual or recurrent glioma after comprehensive treatment.Methods:A total of 57 patients with residual or recurrent glioma in the Affiliated Hospital of Zunyi Medical University and the Second Affiliated Hospital of Zunyi Medical University from January 2018 to September 2020 were retrospectively analyzed.According to different treatment methods,57 patients were divided into the observation group and the control group.The treatment schemes of the two groups were as follows:1.The observation group was treated with apatinib combined with temozolomide or irinotecan,28 cases were included;2.The chemotherapy group（control group）was treated with temozolomide or irinotecan,29 cases were included.The dosage of apatinib（Jiangsu Hengrui）specific use of the program:from the beginning of the treatment,the daily dosage of apatinib is 500mg,and it is appropriate to take it with warm boiled water30 minutes after meals.When the disease progresses or intolerable side effects occur,the dosage of apatinib can be reduced to 250mg;The specific use plan of temozolomide capsules（Jiangsu Tianshili Diyi）was as follows:in the first cycle,the dosage was 150mg/m²/day,oral for 5 days,and withdrawal for 23 days.The drug was taken on an empty stomach and swallowed as a whole;If there is no adverse reaction in the first cycle,the starting dose of the second cycle can be increased to 200mg/m²/day.Irinotecan（Jiangsu Hengrui）specific use plan is as follows:the dosage is 250-350 mg/m²,saline diluted intravenous drip,time is about 30-90 minutes,21 days as a cycle.The drug was stopped when the disease progressed or intolerable adverse symptoms appeared.They were followed up to February 2021.SPSS18.0 software was used to analyze the clinical efficacy and safety of the two groups.In the course of treatment,the related adverse reactions were evaluated and managed according to the Common Terminology Criteria for Adverse Events[CTCAE V5.0]^[1].The dosage or withdrawal of the drug could be adjusted according to the severity of the adverse reactions.Results:（1）Short term efficacy valuation:There were measurable intracranial lesions in both groups.The proportion of partial response（PR）and stable disease（SD）in the observation group was 10.71%（3/28）and 64.28%（18/28）,separately.In the control group,3.45%（1/29）had partial response（PR）and 51.72%（15/29）had stable disease（SD）.The incidence of disease progression（PD）in the observation group and the control group was 25.00%（7/28）and 44.83%（13/29）,separately.No patients in the two groups achieved complete response（CR）.The objective response rate（ORR）and disease control rate（DCR）of the observation group were 10.71%（3/28）and 75.00%（21/28）respectively.In the control group,the objective response rate（ORR）was 3.45%（1/29）,and the disease control rate（DCR）was 55.17%（16/29）,There was no significant difference in ORR and DCR between the two groups（p>0.05）.（2）Survival analysis:The mean progression-free survival of the observation group was10.4 months,while the control group was 7.8 months.The mean survival time of the observation group was 21.3 months,but the mean survival time of the control group only was 15.2 months.And there was no important difference in survival analysis between the two groups（p>0.05）.Cox multivariate analysis showed that gender,age,pathological grade,Ki-67 level,IDH mutation,Mgmt methylation and treatment methods were not significantly correlated with overall survival（p>0.05）.（3）Adverse events:The main non-hematological adverse events in the observation group were rise blood pressure（10/28）,nausea and vomiting（9/28）,transient positive urine protein（6/28）,hand foot syndrome（HFS）（5/28）,apparatus bleeding（2/28）.The common adverse events in the control group were nausea and vomiting（10/29）.Both groups could cause hematological adverse events such as myelosuppression,coagulation dysfunction,transaminase elevation,with grade I-II being the most common,tolerable and safety.Apatinib can benefit patients withresidual or recurrent gliomas and has a survival a dvantage.Conclusion:（1）For patients with residual or recurrent gliomas,the short-term clinical efficacy of apatinib combined with chemotherapy group is better than that of simple chemotherapy group,but there is no statistical significance.（2）Apatinib combined with chemotherapy can prolong the mean progression free survival and the mean overall survival,there were no significant difference between the two groups.（3）In terms of adverse events,I-II adverse events were the most common in the combination group,which provided an alternative treatment for patients with residual or recurrent glioma.