Abstract: Objective  To investigate the effects and adverse reactions of apatinib in advanced gastric cancer patients. Methods  Two hundred and forty cases of advanced gastric cancer patients who had failed chemotherapy were collected from January 30, 2016 to November 1, 2017 in the First Hospital of Zibo City of Shandong Province and the Central Hospital of Zibo City of Shandong Province. All patients took oral apatinib mesylate, 850 mg/time, 1 time/d, and 28 d as 1 cycle of treatment, during which clinical efficacy, adverse reaction and progression free survival (PFS) and overall survival period (OS) were evaluated. Adopting Cox regression model to analyze risk factors of PFS and OS. Results  Of all 240 patients, no patient reached complete response (CR) standard, 25 patients (10.4%) reached partial response (PR) standard, 113 patients (47.1%) reached stable disease (SD) standard, and 102 patients (42.5%) reached progressive disease (PD) standard. Objective response rate (ORR) and disease control rate (DCR) were 10.4% (25/240) and 57.5% (138/240) respectively. When apatinib was taken as a 2nd line treatment, ORR and DCR were 62.5% (5/8) and 75.0% (6/8) respectively; as 3rd line treatment, the result came to 13.9% (20/144) and 67.4% (97/144); as 4th line treatment, it was 0 and 52.4% (33/63); as 5th line treatment, it was 0 and 8.0% (2/25). Among the various adverse effects of apatinib, the most common ones observed were skin lesion (65.8%, 158/240), fatigue (57.9%, 139/240), gastrointestinal reaction (45.4%, 109/240), and hypertension (38.8%, 93/240).Cox multivariate analysis showed that the change of treatment time (HR=5.028, 95%CI: 1.13015.771, P=0.005) and body mass index (HR=21.069, 95%CI: 4.521127.116, P＜0.001) were the independent risk factors of PFS. BMI change (HR=6.550, 95%CI: 1.08038.455, P=0.039) was independent risk factor of  OS. Conclusion  For patients with advanced gastric cancer who failed with 2nd line and above chemotherapy, oral atatinib still obtain certain DCR and survival gain. Apatinib adverse reactions are various, involving a wide range of organ systems, however are generally controllable.

Key words: Stomach neoplasms, Drug therapy, Apatinib