Clinical Observation Of Bevacizumab Plus Chemotherapy For The Treatment Of Advanced Gastric Cancer

Objective: Bevacizumab (avastin) is a recombinant humanined monoclonal IgGlantibody for vascular endothelial growth factor (VEGF), and it can make an antitumoreffect by inhibiting tumor angiogenesis. This study is to evaluate the role ofbevacizumab combined with chemotherapy for advanced gastric cancer which wasHER-2negative or undefined by testing, and observe the drug safety in the meanwhile.Methods:Collected the clinical date of32patients with advanced gastric cancerfrom2011January to2012December in internal tumour department of our hospital.32patients with advanced gastric cancer were confirmed clearly by histopathology, andwere HER-2negative or undefined by testing, then received bevacizumab combinedwith chemotherapy. Chemotherapy was selected according to the actual situation ofthe patient. The dose of bvacizumab was7.5mg/kg,d1,1cycle every21day, every2cycles to evaluate once efficacy. The efficacy of therapy was evaluated according toRECIST, and toxicity or side effects according to NCI-CTC. The problem of statisticmay use SPSS13.0statistics software. The analysis of efficacy of therapy may use the χ2testing,and use Kaplan-Meier to evaluate survival time.Results: Efficacy was evaluated and side effect was observed in32patients. Of thepatients in first-line regimen was used in18patients, and of the patients in second-lineregimen was used in14patients. According to the standard of response evaluationcriteria in solid tumors (RECIST), the results as the follows: No patient with completeremission,20(62.5%) cases were partial remission,5(15.6%) cases were stableremission, and7(21.9%) cases were progression disease. The objective response rate(CR+PR)was62.5%and the disease control rate(CR+PR+SD) was78.1%, the medianprogression-free survival time(mPFS) was5.5months and the median survival time(mOS) was6.5months. Of the patients in first-line regimen was used in18cases,12cases were partial remission,3cases were stable remission, and3cases were progression disease, ORR66.7%，DCR83.3%，mPFS was6.1month，mOS was7.2month；and of the patients in second-line regimen was used in14cases,8cases werepartial remission,2cases were stable remission, and4cases were progression disease,ORR57.1%，DCR71.4%，mPFS was4.5month，mOS was6.0month. There was nosignificant difference (p＞0.05) between first-line-regimen and second-line-regimenabout ORR (p=0.718) and DCR(p=0.669) by χ2statistic testing, two kinds of patients allcould gain smilar benifit from ORR and DCR. Besides, there was meaning difference(p＜0.05) between of the patients first-line-regimen and second-line-therapy about PFSby Log-rank, p=0.002, so of the patients in first-line regimen could gained morebenifit. No serious accident was occurred for all patients，as thrombosis, gastricperforation, heart failure and so on. Toxicity or side effects of patients were as thefollows,17cases had bone marrow suppression，11cases liver injury,6casesgastrointestinal reactions, and5cases hypertention, in which all toxicities were GradeI-II, and all adverse reactions recovered after symptomatic treatment.2patientshappened mild epistaxis by given the gauze to stuff the nasal cavity, after no happenedagain.Conclusions: Compared with the previous literature chemothrapy date, theregimen of bevacizumab plus chemotherapy can well improve the ORR (62.5%vs30-60%) and DCR (78.1%vs60%) for advanced gastric cancer. There was nosignificant different meaning between the first-line-regimen and second-line-regimenabout ORR and DCR, so two kinds of patients could gain similar benifit here.Meanwhile, patients with abdominal pain，bloating and other cancer-related symptomshad been alleviated in some certain, because the drugs had reduced the tumor loadeffectively. Moreover, the mPFS of all patients becomed longer than the date previouschemotherapy（5.5month vs5.0month）, especially for the patients in first-line regimen,the mPFS prolonged1.1months, the patients in first-line regimen could gained morebenifit. However，the mOS of all patients becomed no longer than the date of previouschemotherapy（6.5month vs6.0-10.5month），considering of the small sample，andmight related with lating regimen,and so on. In addition, side reactions can be toleratedby patients. In conclusion, bevacizumab combined with chemotherapy can apply tothe patients in first-line-regimen of advanced gastric cancer which was HER-2negativeor undefined.