Efficacy And Safety Of Apatinib In The Treatment Of Platinum-Resistant Ovarian Cancer

BackgroundOvarian cancer is one of the most common malignant tumors in gynecology,and the mortality rate is the first in gynecology,which poses a serious threat to the life and health of women.the current standard treatment regimen is still tumor cell attenuated plus platinum-based combination chemotherapy.although most patients have complete remission,approximately 25%of patients still experience a recurrence of platinum resistance within 6 months.once the patient relapses,the prognosis is extremely poor,especially platinum-resistant recurrence,and the choice of treatment options is limited,which poses a serious threat to the patient's life,so it is necessary to study better treatment options to benefit the patient.Apatinib is a newly studied small-molecule vascular endothelial growth factor receptor 2(vascular endothelial growth factor receptor 2,VEGFR-2)tyrosine kinase inhibitor that competitively antagonizes ATP catalytic sites on adenosine triphosphat(adenine nucleoside triphosphate)binding cassette transporters,inhibits efflux of ATP binding cassette transporters,increases the active components of antitumor drugs in tumor cells,and reverses multidrug resistance in tumor cells.But apatinib in the breast,solid malignant tumors such as stomach and lung sites have been approved for clinical application,and the effect is remarkable,suggesting that apatinib has a broad application prospect in the treatment of various solid tumors.PurposeTo evaluate the clinical efficacy and safety of apatinib in the treatment of platinum-resistant ovarian cancer,and to provide reference for doctors to formulate platinum-resistant ovarian cancer program.MethodsRetrospective analysis of platinum-resistant recurrent ovarian cancer patients treated in the first affiliated hospital(our hospital)of zhengzhou university from july 2015 to january 2019.inclusion criteria:1 age 18?70 years old,complete satisfactory tumor cell subtraction and platinum drugs chemotherapy after tumor-free survival time<6 months;2 histopathology was primary epithelial ovarian cancer;3 abdominal computed tomography(Computed Tomography,CT)revealed at least 1 measurable lesion?10 mm;4 normal liver and kidney function,normal bone marrow hematopoietic function,cardiac function grade i? ii.Exclusion criteria:1 platinum sensitivity recurrence patients after completing platinum drug chemotherapy,the tumor-free survival time>6 months;2 histopathology was nonepithelial ovarian cancer;36 months had been treated with antiangiogenic drugs;4 there were severe liver and kidney function damage,severe heart disease,bone marrow hematopoietic dysfunction.patients were informed of the relevant advantages and disadvantages and risks of the study and signed informed consent.The 46 patients were divided into two groups according to the treatment plan,chemotherapy alone(n=25),namely gemcitabine oxaliplatin,in which gemcitabine was administered intravenously on day 1 and day 8 at a dose of 1000 mg/m2,and oxaliplatin was 130mg/m2 dose was administered intravenously on day 2,28 days as a course of treatment,and chemotherapy for 2?6 courses.the apatinib combined with chemotherapy group(n=21 cases),i.e.apatinib(500 mg,once a day,orally)gemcitabine oxaliplatin,in which gemcitabine and oxaliplatin were used in the same way and dosage as chemotherapy-only group,with severe side effects during medication,apatinib reduced to 250 mg.The evaluation index[according to the evaluation criteria(RECIST)and CA125 level of solid tumor curative effect]:the mass disappeared after treatment,the tumor marker CA125 decreased to normal,for complete remission.ResultsThe general clinical data(age,pathological type,FIGO stage,mass recurrence size(cm),tumor grade,number of metastatic sites,serum CA125 index before treatment,ascites)were not statistically significant in the two groups.apatinib combined with chemotherapy(gemcitabine oxaliplatin)was significantly better in ORR(p=0.047<0.05)and DCR(p=0.043<0.05)than in chemotherapy alone(gemcitabine oxaliplatin).The CA125 levels in the chemotherapy group alone(6 patients with PR,24.0%)and the apatinib combined chemotherapy group(11 patients with PR,52.4%)were(72.37±23.33)U/mL and(49.59 ±18.61)U/mL,respectively,with statistically significant differences(t=2.210,p=0.043).Regarding the incidence of hypertension,hand and foot skin reaction,apatinib combined with chemotherapy group is higher than that of simple chemotherapy group,but all of them are in grade 1-3,and symptomatic support treatment can be alleviated.In the course of this study,the two groups of toxic side effects were relieved after reduction and symptomatic support treatment.ConclusionsApatinib combined with chemotherapy for platinum-resistant ovarian cancer is safe and has a certain effect,which provides a new treatment scheme for patients with platinum-resistant ovarian cancer.