The Efficacy And Safety Of Apatinib In Advanced Non-small Cell Lung Cancer After Second-line And More Regimens Failure

Objective :Currently,there is no standard treatment for patients with advanced metastatic non-small cell lung cancer(NSCLC)experiencing progression after two or more lines of treatment.Clinical trials and palliative treatment are recommended by guidelines.The aim of this study was to assess the efficacy and safety profiles of apatinib in the treatment of advanced NSCLC patients who had failed with second-line or more treatments.Methods : We retrospectively reviewed advanced NSCLC patients experiencing progression after second-line and more treatments who had received apatinib as a third-line or more chemotherapy regimen at Chongqing Cancer Hospital between March 2016 to February 2018.Patients were treated with oral apatinib500 mg QD,every 4 weeks for a cycle.Responding and stable patients continued the treatment until progression or unacceptable toxicity.Follow-up time was until the death of the patient or to the end day of the study.The overall survival(OS),progression free survival(PFS),objective remission rate(ORR)and disease control rate(DCR)and side effects of the drug were evaluated.The efficacy and safety were evaluated by RECIST 1.1 and NCI-CTCAE 4.0 criteria.The Kaplan-Meier method was performed for survival analysis.Univariate and multivariate Cox regression analyses were used to explore the independent predictors influencing the survival of advanced metastatic NSCLC patients experiencing progression after two or more lines of treatmet.Results :A total of 52 patients retrospectively enrolled.The objective response rate(ORR)and the disease control rate(DCR)were 5.7% and 73.0%.The median progression-free survival(PFS)and median overall survival(OS)of all patients treated with apatinib as third-line or more were 3.8 months and 5.8 months,respectively.Cox univariate analysis showed that ECOG score affected the PFS and OS of advanced NSCLC patients treated with apatinib as third-line or more.Patients with ECOG 0-1 scores had prolonged PFS compared with ECOG 2 patients(3.9months vs 2.1 months,P=0.029),and patients with ECPG 0-1 scores had longer OS than ECOG 2 patients(6.4 months vs.4.1 months,P=0.046).The gender,age,smoking status,pathology type and EGFR status of pathents were not the predictors of PFS and OS.The multivariate analysis also showed that the ECOG score was the independent influencing factor of PFS and OS for the advanced NSCLC patients who were treated with apatinib after second-line and above standard regimens progression(PFS:HR=4.446,95%CI:1.185-16.678,P=0.027;OS:HR=8.149,95%CI:1.173-56.596,P=0.034).The most common adverse events apatinib treatmentrelated included high blood pressure,hand-foot syndrome,oral mucosal ulcers.And treatment-related grade 3/4 toxicities were low.Conclusion : Apatinib showed favorable efficacy and safety,and could be a treatment option for patients with advanced NSCLC experiencing progression after second-line and more treatment.