关键词: 胃肿瘤, 甲胎蛋白类, 阿帕替尼, 多西他赛

Abstract: Objective  To observe the efficacy and safety of apatinib combined with docetaxel in the third line and above treatment of advanced serum alpha-fetoprotein-positive gastric cancer (AFPGC). Methods  A total of 41 patients with AFPGC from February 2015 to April 2018 in Suining Central Hospital of Sichuan Province were retrospectively analyzed. The patients were divided into experimental group and control group according to different treatment methods, 15 patients in the experimental group received with apatinib combined with docetaxel, and 26 patients in the control group received chemotherapy alone or optimal nutritional support. The short-term efficacy, long-term efficacy and adverse reactions were evaluated by Response Evaluation Criteria in Solid Tumours (RECIST) version 1.1, progression-free survival (PFS), overall survival (OS) and National Cancer Institute Common Terminology Criteria for Adverse Events (NCI CTCAE) version 4.0. Results  After 2 cycles of treatment, no complete remission (CR) was achieved in either group, 4 partial remission (PR), 7 stable disease (SD), 4 progressive disease (PD) in the experimental group, and 2 PR, 7 SD, 17 PD in the control group. The objective response rate (ORR) was 26.67% (4/15) and 7.69% (2/26) respectively in the experimental group and the control group, with no significant difference (χ2=1.433, P=0.231). The disease control rate (DCR) was 73.33% (11/15) and 34.62% (9/26) respectively in the two groups, with significant difference (χ2=5.707, P=0.017). The median PFS of the experimental group and the control group were both 3.0 months, and there was no significant difference between the two groups (χ2=4.425, P=0.350). The median OS were 6.0 months and 4.0 months respectively, and the difference was statistically significant (χ2=5.727, P=0.017). The occurrence rates of leukopenia of the experimental group and the control group were 73.33% (11/15) and 30.77% (8/26), the occurrence rates of hypertension were 40.00% (6/15) and 0 (0/26), the occurrence rates of proteinuria were 26.67% (4/15) and 0 (0/26), the occurrence rates of poor appetite were 80.00% (12/15) and 38.46% (10/26), and the occurrence rates of hemorrhage were 33.33% (5/15) and 3.85% (1/26). The occurrence rates of the above adverse reactions in the experimental group were significantly higher than those in the control group (χ2=6.930, P=0.008; χ2=9.191, P=0.002;  χ2=4.953, P=0.026; χ2=6.600, P=0.010; χ2=4.471, P=0.034), and the differences were statistically significant. There was no significant difference in the incidence of thrombocytopenia, anemia, nausea and vomiting, diarrhea, fatigue and hand-foot syndrome between the two groups (all P>0.05). Conclusion  The DCR of apatinib combined with docetaxel in the third-line and above treatment of advanced AFPGC patients is higher. This scheme can prolong survival period, and the adverse reactions are more serious, but they are basically tolerable.

Key words: Stomach neoplasms, alpha-Fetoproteins, Apatinib, Docetaxel