| BackgroundGastric cancer is one of the most common gastrointestinal malignancies in the world,and is currently the second leading cause of death in China.The increasing incidence and mortality of gastric cancer have brought a heavy burden on the development of public health worldwide.Because the clinical symptoms of advanced gastric cancer are not typical,and the public’s awareness and autonomy of screening for such diseases are not strong,patients with gastric cancer are diagnosed as middle and late stage or have already distant metastasis at the time of initial diagnosis.Radical treatment such as surgical resection cannot be implemented,and only palliative or conservative treatment can be carried out.In addition,the poor physical condition of some patients also limits the choice of treatment methods.Therefore,for advanced or metastatic gastric cancer,there are few treatment options available,among which chemotherapy is the most important treatment method at present.With the rapid development of society and medicine,more and more chemotherapy drugs have been applied in clinical practice,but the adverse reactions caused by chemotherapy drugs are mostly severe,so the dosage of chemotherapy drugs is limited and the efficacy of chemotherapy drugs is stillnot satisfactory.Now,there are more and more new biomolecular targeted drugs such as monoclonal antibodies,small molecule inhibitors,biological agents and so on applied in clinical,and because of its targeting,the adverse reactions are mostly controllable,most patients can also tolerate,as expected,its efficacy has been recognized by the majority of people.Among them,apatinib,a small-molecule vascular endothelial growth factor inhibitor,has been approved by the food and drug administration of China for third-line and above treatment of advanced gastric cancer and the gastroesophageal junction adenocarcinoma,showing prominent reactivity rate and controllable adverse reactions in phase II and III clinical trials.However,it is rarely reported that apatinib is used for second-line treatment of gastric cancer.ObjectiveTo observe for the first time the clinical efficacy and survival analysis of apatinib combined chemotherapy in the treatment of advanced gastric cancer as second-line treatment.MethodsSelected 72 patients with advanced gastric cancer,from 2016.03 to 2017.04 of the First Affiliated Hospital of Zhengzhou University,were randomly divided into chemotherapy group,apatinib group,apatinib combination chemotherapy group to be conducted retrospective analysis.More attention,all patients should be stopped receiving treatment when disease progression(PD)or intolerable adverse reactions occurred,before which the curative effect were periodically evaluated every two treatment cycles.As a result,we could analyze and compare the clinical efficacy,adverse reactions and survival benefit among the three groups.ResultsFor chemotherapy group,apatinib group,apatinib combination chemotherapy group,the disease control rate(DCR)and objective response rate(ORR)were 48.3%,61.1%,72.0%(P > 0.05)and 13.8%,16.7%,28.0%(P > 0.05),respectively.The incidence rate of adverse reaction at grade three-four was 17.1%,16.8% and 24.0%(P>0.05),respectively.Reference to the chemotherapy group(93d),the median freeprogressive survival(mPFS)time in the apatinib group and apatinib combination chemotherapy group was 117d(P =0.128)and 160d(P =0.001).Furthermore,TNM staging(P=0.036)、 ascites(P=0.041)and treatment regimen(P=0.001)were independent factors affecting PFS.ConclusionsAs the second-line treatment in advanced gastric cancer,compared with single chemotherapy and single apatinib group,apatinib combined with chemotherapy group displays more satisfactory achievement in high remission rate,accompanied by controllable adverse reactions and considerable survival benefit. |
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