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Efficacy of apatinib combined with tegafur gimeracil and oteracil potassium in the second-line treatment of advanced gastric cancer.

PURPOSE
To investigate the clinical efficacy and safety of apatinib combined with tegafur-gimeracil-oteracil potassium (S-1) in the second-line treatment of advanced gastric cancer.


METHODS
A total of 126 patients with advanced gastric cancer admitted to our hospital from January 2017 to September 2018 were enrolled as the research objects, none of whom underwent surgery. For these patients, second-line treatment was recommended due to the failure of first-line treatment. According to the different therapeutic options, patients were categorized into S-1 group (n=63) and Apatinib group (S-1 combined with apatinib, n=63), and drugs were administered orally. The clinical efficacy, serological indicators, adverse reactions and immune function were compared between the two groups. Besides, the survival status of patients was recorded through follow-up.


RESULTS
In S-1 group and Apatinib group, the objective response rate (ORR) was 30.2% (19/63) vs. 50.8% (32/63) and the disease control rate (DCR) was 54.0% (34/63) vs. 74.6% (47/63), respectively. The results indicated that Apatinib group was superior to S-1 group in terms of ORR and DCR, suggesting statistically significant differences (p=0.018, p=0.016). Compared with those before treatment, the serum levels of carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA), and tumor supplied group of factors (TSGF) in the two groups of patients were prominently reduced after treatment (p<0.05). After treatment, CA19-9 and TSGF levels were remarkably lower in Apatinib group than those in S-1 group (p=0.008, p=0.023), and there was no statistically significant difference in the CEA level between the two groups (p=0.057). After treatment, the quality of life of patients was improved notably in Apatinib group compared with that in S-1 group (p=0.002). Adverse reactions mainly involved hematological toxicity, nausea and vomiting, abnormal renal function, impairment of hepatic function, neurotoxicity, hypertension and hand-foot syndrome, most of which were in grade I-II and relieved after symptomatic treatment and could be tolerated for continued treatment. Serious adverse reactions in grade III-IV occurred rarely. No statistically significant difference was found in the incidence rate of adverse reactions between the two groups of patients (p>0.05). Besides, according to the follow-up results, median overall survival (OS) was 8.1 months vs. 10.7 months and median progression-free survival (PFS) was 4.2 months vs. 5.3 months, respectively, in S-1 group and Apatinib group. The results of log-rank test demonstrated that Apatinib group was superior to S-1 group with respect to OS, showing a statistically significant difference (p=0.028), and no statistically significant difference was found in PFS between the two groups of patients (p=0.159).


CONCLUSION
In the second-line treatment of advanced gastric cancer, apatinib combined with S-1 is superior to S-1 alone in term of clinical efficacy, and its adverse reactions can be tolerated. Apatinib combined with S-1 can prominently improve the quality of life, reduce the serum tumor marker levels and prolong the OS of patients, but it cannot extend the PFS.