Efficacy and prognosis analyses of apatinib combined with S-1 in third-line chemotherapy for advanced gastric cancer

Purpose: 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. Methods: 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. Results: 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. Conclusion: 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.