Department of Radiotherapy, Hainan Cancer Hospital, Haikou, China.
Department of Gastroenterology, Hainan West Central Hospital, Danzhou, China.
Chemotherapy. 2024;69(1):11-22. doi: 10.1159/000531524. Epub 2023 Jun 20.
At present, there are several studies on low-dose apatinib combined with chemotherapy as a second-line treatment of advanced gastric cancer (AGC), but the conclusions are controversial. Therefore, this meta-analysis aimed to evaluate the efficacy and safety of low-dose apatinib combined with chemotherapy as a second-line treatment of AGC.
Nine databases were searched for records on apatinib combined with chemotherapy in treating AGC from inception to June 2022. The observation group received low-dose apatinib combined with chemotherapy, while the controls received chemotherapy alone or other non-placebo treatments. Outcomes included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), overall survival (OS), and adverse events. The relative risk (RR) and weighted mean difference (WMD) were used as effect sizes.
Eight studies involving 679 patients were included in this meta-analysis. The results of the meta-analysis showed that the observation group was superior to the controls in terms of ORR (RR = 1.38, 95% confidence interval [CI]: 1.05-1.81, p = 0.02), DCR (RR = 1.35, 95% CI: 1.20-1.53, p < 0.001), OS (WMD = 4.72, 95% CI: 0.71-8.72, p < 0.001), and PFS (WMD = 2.67, 95% CI: 1.7-3.63, p < 0.001). There were no significant differences between the two groups in adverse events of any grade except hypertension (RR = 2.82, 95% CI: 2.07-3.84, p < 0.001), hand-mouth syndrome (RR = 1.84, 95% CI: 1.84-2.48, p < 0.001), and proteinuria (RR = 3.63, 95% CI: 2.31-5.7, p < 0.001).
Low-dose apatinib combined with chemotherapy as a second-line therapy is more effective in improving the efficacy of AGC compared to chemotherapy alone. However, this option has the potential to increase the risk of hypertension, hand-mouth syndrome, and proteinuria.
目前，有几项关于低剂量阿帕替尼联合化疗作为晚期胃癌（AGC）二线治疗的研究，但结论存在争议。因此，本荟萃分析旨在评估低剂量阿帕替尼联合化疗作为 AGC 二线治疗的疗效和安全性。
从建库至 2022 年 6 月，我们在 9 个数据库中检索了阿帕替尼联合化疗治疗 AGC 的记录。观察组接受低剂量阿帕替尼联合化疗，对照组接受化疗或其他非安慰剂治疗。结局包括客观缓解率（ORR）、疾病控制率（DCR）、无进展生存期（PFS）、总生存期（OS）和不良事件。相对危险度（RR）和加权均数差（WMD）用作效应量。
本荟萃分析纳入了 8 项涉及 679 名患者的研究。荟萃分析结果显示，观察组在 ORR（RR=1.38，95%置信区间[CI]：1.05-1.81，p=0.02）、DCR（RR=1.35，95%CI：1.20-1.53，p < 0.001）、OS（WMD=4.72，95%CI：0.71-8.72，p < 0.001）和 PFS（WMD=2.67，95%CI：1.7-3.63，p < 0.001）方面均优于对照组。除高血压（RR=2.82，95%CI：2.07-3.84，p < 0.001）、手足综合征（RR=1.84，95%CI：1.84-2.48，p < 0.001）和蛋白尿（RR=3.63，95%CI：2.31-5.7，p < 0.001）外，两组间其他任何等级的不良反应发生率均无显著差异。
与单纯化疗相比，低剂量阿帕替尼联合化疗作为二线治疗更能提高 AGC 的疗效。然而，这种选择可能会增加高血压、手足综合征和蛋白尿的风险。
