Safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with peritoneal metastasis.
10.3760/cma.j.cn.441530-20200530-00326
- VernacularTitle:阿帕替尼联合奥沙利铂和替吉奥在胃癌腹膜转移转化治疗中的安全性及近期疗效观察
- Author:
Zai Sheng YE
1
;
Yi ZENG
1
;
Sheng Hong WEI
1
;
Yi WANG
1
;
Shu CHEN
1
;
Zhi Tao LIN
1
;
Zhi Wei WANG
1
;
Xiao Ling CHEN
1
;
Lu Chuan CHEN
1
Author Information
1. Department of Gastrointestinal Surgery, Key Laboratory of Tumor Biological Treatment of Fujian Province, Fujian Cancer Hospital & Affiliated Cancer Hospital, Fujian Medical University, Fuzhou 350014, China.
- Publication Type:Journal Article
- Keywords:
Apatinib;
Conversion therapy;
Peritoneal metastasis;
Stomach neoplasm
- MeSH:
Aged;
Antineoplastic Combined Chemotherapy Protocols/therapeutic use*;
Female;
Humans;
Male;
Middle Aged;
Oxaliplatin;
Percutaneous Coronary Intervention;
Peritoneal Neoplasms/drug therapy*;
Prospective Studies;
Pyridines;
Retrospective Studies;
Stomach Neoplasms/drug therapy*
- From:
Chinese Journal of Gastrointestinal Surgery
2021;24(3):240-247
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To investigate the safety and short-term efficacy of apatinib combined with oxaliplatin and S-1 in the conversion treatment for gastric cancer with different types of peritoneal metastasis. Methods: A prospective study "one arm exploratory clinical study of conversion therapy of apatinib with S-1 and oxaliplatin in the treatment of advanced gastric cancer" (clinical registration ChiCTR-ONC-17010430) from medical record database was retrospectively analyzed. Patients aged 18-70 years with gastric cancer peritoneal metastasis confirmed by histology and laparoscopic exploration, and had not receive radiotherapy, chemotherapy, targeted therapy or immunotherapy before were enrolled. Before operation, the patients received 6 cycles of S-1 (80-120 mg/d, d1-d14) and oxaliplatin (130 mg/m(2), d1), and 5 cycles of apatinib (500 mg/d, d1-d21) conversion regimen. Three weeks after chemotherapy, whether the operation was performed or not depending on re-evaluation and patient preference. The main outcome were adverse reactions, and the secondary outcome were objective remission rate (ORR), disease control rate (DCR), and overall survival (OS) rate. The follow-up period was up to May 2020. Results: A total of 27 patients with gastric cancer peritoneal metastasis were enrolled in this study. There were 13 males and 14 females, with a median age of 58 (30-68) years old. There were 9 cases of P1a, 5 cases of P1b, and 13 cases of P1c. There were 14 cases with 1-5 scores of PCI (peritoneal cancer index), and 13 cases with 6 scores or above. The incidence of adverse reactions was 100%. The most common adverse reactions were hematological events including leucopenia (70.4%, 19/27) and granulocytopenia (74.1%, 20/27). Non-hematological adverse events included fatigue (51.9%, 14/27) and oral mucositis (37.0%, 10/27). One patient was withdrawn due to grade 4 thrombocytopenia. Among 26 patients with feasible efficacy evaluation, 18 (69.2%) achieved partial remission, 3 (11.5%) achieved stable disease, and 5 (19.2%) disease progression. The objective remission rate was 69.2% (18/26) and the disease control rate was 80.8% (21/26). Fourteen patients underwent surgery, including 6 patients undergoing R0 resection with the R0 resection rate of 42.9% (6/14). The postoperative pathological response rate was 64.3% (9/14). The follow-up time was 12-40 months, and the follow-up rate was 100%. The 1-year OS rate was 65.2% and the survival time was (14.0±1.7) months. The 1-year OS rates of P1a/P1b group and P1c group were 81.8% and 42.0% respectively, whose difference was statistically significant (P=0.041). The 1-year OS rates of PCI 1-5 group and PCI ≥6 group were 67.3% and 38.5% respectively, whose difference was statistically significant (P=0.022). Conclusion: In the conversion treatment of gastric cancer peritoneal metastasis, the safety of apatinib combined with oxaliplatin and S-1 is acceptable, and this regimen shows a good short-term survival efficacy in patients with P1a/P1b and PCI of 1-5.
