Wu Qiuju, Fu Yingchun, Wen Wenlong, Xi Ting, Zhao Guangling
Department of Gastroenterology, Liaocheng People's Hospital, Liaocheng, China.
J BUON. 2020 Mar-Apr;25(2):987-994.
To explore the efficacy and safety of apatinib (an anti-angiogenic drug) combined with S-1 (a fluorouracil drug) in the third-line chemotherapy for advanced gastric cancer, and to analyze the factors influencing the prognosis.
Eighty-four patients with advanced gastric cancer, who did not respond to second-line or above chemotherapy and were treated in our hospital were enrolled and divided into Apatinib+S-1 group (n=42) and S-1 group (n=42), based on different treatments applied. Next, the clinical responses and adverse reactions of patients were observed and recorded. The patients were followed up through the outpatient service and telephone to record their survival and disease progression. Additionally, the factors affecting the prognosis of patients were analyzed.
The objective response rate (ORR) and disease control rate (DCR) in the Apatinib+S-1 group were 9.5% (4/42) and 71.4% (30/42), respectively, which were significantly higher than those in the S-1 group. The main adverse reactions after therapy included neutropenia, thrombocytopenia, anemia, stomatitis, hypertension, proteinuria, hand-foot syndrome and gastrointestinal reaction, which were mostly of grade I-II. The incidence rates of hypertension, proteinuria and hand-foot syndrome were 42.9%, 26.2%, and 23.8%, respectively, in the Apatinib+S-1 group, which were overtly higher than those in the S-1 group. There was no statistically significant difference in the overall survival (OS) of patients between two groups (p=0.063), while the progression free survival (PFS) of patients was overtly longer in the Apatinib + S-1 group than that in S-1 group. Univariate analysis of PFS showed that the PFS of patients with high differentiation of tumor or post-treatment proteinuria or hand-foot syndrome was evidently higher than that of patients without high differentiation of tumor or post-treatment proteinuria or hand-foot syndrome.
Patients with advanced gastric cancer achieve relatively satisfactory short-term therapeutic effects after treatment with apatinib combined with S-1 in the third-line therapy, whose PFS is notably better than those treated with S-1 alone, and they are tolerant to adverse reactions. Highly differentiated tumors and post-treatment proteinuria and hand-foot syndrome are predictable factors for the PFS of patients.
探讨阿帕替尼（一种抗血管生成药物）联合S-1（一种氟尿嘧啶类药物）用于晚期胃癌三线化疗的疗效及安全性，并分析影响预后的因素。
选取我院收治的84例对二线及以上化疗无反应的晚期胃癌患者，根据治疗方法不同分为阿帕替尼+S-1组（n=42）和S-1组（n=42）。随后，观察并记录患者的临床反应及不良反应。通过门诊及电话对患者进行随访，记录其生存及疾病进展情况。此外，分析影响患者预后的因素。
阿帕替尼+S-1组的客观缓解率（ORR）和疾病控制率（DCR）分别为9.5%（4/42）和71.4%（30/42），显著高于S-1组。治疗后的主要不良反应包括中性粒细胞减少、血小板减少、贫血、口腔炎、高血压、蛋白尿、手足综合征及胃肠道反应，大多为Ⅰ-Ⅱ级。阿帕替尼+S-1组高血压、蛋白尿及手足综合征的发生率分别为42.9%、26.2%和23.8%，明显高于S-1组。两组患者的总生存期（OS）差异无统计学意义（p=0.063），而阿帕替尼+S-1组患者的无进展生存期（PFS）明显长于S-1组。PFS的单因素分析显示，肿瘤高分化或治疗后出现蛋白尿或手足综合征的患者的PFS明显高于无肿瘤高分化或治疗后蛋白尿或手足综合征的患者。
晚期胃癌患者采用阿帕替尼联合S-1进行三线治疗后可获得相对满意的短期治疗效果，其PFS明显优于单纯使用S-1治疗的患者，且对不良反应耐受性良好。高分化肿瘤及治疗后蛋白尿和手足综合征是患者PFS的预测因素。
