| Background:In recent years,targeted therapy has made great strides and enabled more and more patients with malignant tumors to achieve clinical benefits.Apatinib,an anti-angiogenesis-targeted drug,was launched in October 2014 and was shown to be a safe and effective oral agent after failure of standard chemotherapy for advanced gastric cancer.Apatinib is an oral small molecule multi-target tyrosine kinase inhibitor,which inhibits the ATP binding site of intracellular vascular endothelial growth factor receptor-2（VEGFR-2）by highly selective competition,hinders its binding to the corresponding receptor targeted drug,inhibits the downstream information transduction mediated by VEGFR-2,inhibits the production of tyrosine kinase to inhibit tumor tissue angiogenesis,deprives tumors of oxygen and nutrient supply,and ultimately achieves the purpose of inhibiting tumor growth and metastasis.Objective:Retrospectively analyze the efficacy and adverse reactions of apatinib monotherapy,apatinib combined with chemotherapy and apatinib combined immunotherapy for advanced gastric cancer,and explore the prognostic indicators affecting the progression-free survival of patients with advanced gastric cancer.Methods:From January 2015 to December 2020,176 patients with advanced gastric cancer who were admitted to the First Affiliated Hospital of Bengbu Medical College and failed first-or second-line chemotherapy were collected.The time and dosage of the patients were collected,and according to the dosage of apatinib,it was divided into two groups of 250mg（group A）and 500mg（group B）,and each group of patients was divided into apatinib monotherapy,apatinib combined chemotherapy and apatinib combined immunization according to different treatment regimens.Comparing the efficacy and safety of apatinib monotherapy,apatinib combined chemotherapy and apatinib combined with immune second-line treatment of advanced gastric cancer,as well as the efficacy and safety of third-line treatment of advanced gastric cancer,the prognostic indicators affecting the progression-free survival of patients with advanced gastric cancer were explored.Results:1.In the second-line treatment of group A,the median progression-free survival（m PFS）of apatinib monotherapy,apatinib combined chemotherapy and apatinib combined immunity was 3.7 months,7.7 months,and 8.4 months,respectively,and the median overall survival（m OS）was 7.8 months,10.7 months,and 12.5 months,respectively.Compared with apatinib monotherapy,apatinib combined with chemotherapy and apatinib combined immunity significantly prolonged m PFS and m OS in patients,and the difference was statistically significant（P<0.05）.Moreover,the adverse reactions in A groups can be tolerated.2.In the second-line treatment of group B,the median progression-free survival（m PFS）of apatinib monotherapy,apatinib combined chemotherapy and apatinib combined immunity was 3.6 months,8.6 months,and 9.0 months,respectively,and the median overall survival（m OS）was 7.3 months,11.9 months,and 14.3 months,respectively;Compared with apatinib monotherapy,apatinib combined with chemotherapy and apatinib combined immunity significantly prolonged m PFS and m OS in patients,and the difference was statistically significant（P<0.05）.Moreover,the adverse reactions in B groups can be tolerated.3.In the three treatment regimens of apatinib monotherapy,apatinib combined with chemotherapy and apatinib combined with immunization in group A,the number of cases of grade III-IV adverse reactions was 5 cases（25%）,6 cases（10.5%）,and 2cases（22.2%）,respectively,with no statistically significant difference（P=0.173>0.05）.4.In the three treatment regimes of apatinib monotherapy,apatinib combined chemotherapy and apatinib combined immunization in group B,the number of cases of grade III-IV adverse reactions was 6 cases（22.2%）,15 cases（28.3%）,and 3cases（30%）,with no statistically significant difference（P=0.779>0.05）.5.In the second-line treatment of group A and B,when apatinib is combined with chemotherapy in the treatment of patients with advanced gastric cancer,the overall survival of the patient may be prolonged when the apatinib 500 mg dose is selected（P<0.05）.In the second-and third-line treatments of group A and B,the adverse reactions of apatinib at a dose of 250 mg in apatinib combined with chemotherapy were mild and better tolerated（P<0.05）.6.After COX multivariate regression analysis in group A and group B,the results showed that in the second-line treatment of advanced gastric cancer,ECOG,whether peritoneal metastasis occurred and whether the combination of drugs were related to the progression-free survival of patients with advanced gastric cancer,and the correlation was statistically significant（P<0.05）.Conclusion:In the second-line treatment of patients with advanced gastric cancer,in the case of no obvious abnormalities in their physical state and heart,liver and kidneys and can be tolerated,compared with apatinib monotherapy,apatinib combined with chemotherapy and apatinib combined immunity can significantly improve the progression-free survival time and overall survival of advanced gastric cancer,and the safety is reliable.The patient’s physical status and presence or absence of peritoneal metastases can affect the efficacy of advanced gastric cancer. |
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