Effects of apatinib combined with chemoradiotherapy on the efficacy and tumor markers of advanced gastric cancer

doi:10.3760/cma.j.cn371439-20210610-00118

Abstract

Abstract:

Objective To observe the short- and long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer and its effect on tumor markers. Methods From January 2013 to January 2017, 84 patients with advanced gastric cancer admitted to the Department of Oncology of Chang'an Hospital of Xi'an City were selected as the subjects. The patients were divided into synchronous chemoradiotherapy group and targeted chemoradiotherapy group by prospective nested control method, with 42 cases in each group. The synchronous chemoradiotherapy group was treated with synchronous chemoradiotherapy, and the targeted chemoradiotherapy group was treated with apatinib combined with chemoradiotherapy, 2 weeks was a cycle, a total of 12 cycles. The short- and long-term efficacy, median overall survival, changes of gastric cancer-related markers and adverse reactions of the two groups were compared. Results After 3 months of treatment, there was no significant difference in the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group (Z=0.240, P=0.887). The disease control rates of the two groups were 69.05% (29/42) and 73.81% (31/42) respectively, with no statistically significant difference (χ²=0.233, P=0.629). After 6 months of treatment, the difference of the efficacy distribution between the synchronous chemoradiotherapy group and the targeted chemoradiotherapy group was statistically significant (Z=6.288, P=0.043), and the disease control rates of the two groups were 42.86% (18/42) and 69.05% (29/42) respectively, with a statistically significant difference (χ ²=5.845, P=0.016). The median overall survival in the targeted chemoradiotherapy group and synchronous chemoradiotherapy groups were 18.7 months (95%CI: 8.4-24.8) and 13.8 months (95%CI: 7.2-18.7), with a statistically significant difference (χ ²=7.542, P<0.001). After 3 months of treatment, the levels of carbohydrate antigen (CA) 19-9, CA125, carcino-embryonic antigen (CEA) were (16.27±2.13) U/ml, (13.25±2.26) U/ml, (2.97±0.85) ng/ml in the targeted chemoradiotherapy group and (29.34±3.69) U/ml, (21.63±2.69) U/ml, (6.19±1.23) ng/ml in the synchronous chemoradiotherapy group respectively, all of them were lower than those before treatment, and the CA19-9, CA125, CEA in the targeted chemoradiotherapy group were lower than those in the synchronous chemoradiotherapy group, and there were statistically significant differences (t=19.880, P<0.001; t=15.458, P<0.001; t=13.957, P<0.001). The total incidence of grade 3-4 adverse reactions in the targeted chemoradiotherapy group was 23.81% (10/42) and 28.64% (12/42) in the synchronous chemoradiotherapy group, and there was no statistically significant difference (χ ²=0.186, P=0.667). Conclusion The long-term efficacy of apatinib combined with chemoradiotherapy in the treatment of advanced gastric cancer is better than that of synchronous chemoradiotherapy, and it is safe and reliable. At the same time, it can prolong the overall survival and reduce the levels of serum tumor markers.

Key words: Stomach neoplasm, Radiotherapy, Drug therapy, Biomarkers, Apatinib

Wang Xuan, Cui Lichun, Dang Shengqiang. Effects of apatinib combined with chemoradiotherapy on the efficacy and tumor markers of advanced gastric cancer[J]. Journal of International Oncology, 2021, 48(10): 602-607.

Figures/Tables 6

References 22

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基本特征	同步放化疗组 (n=42)	靶向放化疗组 (n=42)	χ²/t值	P值
性别
男	22(52.38)	23(54.76)	0.048	0.827
女	20(47.62)	19(46.24)
年龄(岁)	56.83±4.82	56.71±4.92	0.113	0.910
体力状况评分(分)
0	24(57.14)	25(59.52)
1	12(28.57)	12(28.97)	0.111	0.946
2	6(14.29)	5(11.91)
主要转移部位
骨	4(9.52)	3(7.14)
肝	6(14.29)	7(16.67)	0.380	0.827
肾	2(4.73)	3(7.14)

组别	完全缓解	部分缓解	病情稳定	疾病进展	疾病控制
同步放化疗组(n=42)	0(0)	10(23.81)	19(45.24)	13(30.95)	29(69.05)
靶向放化疗组(n=42)	0(0)	11(26.19)	20(47.62)	11(26.19)	31(73.81)
Z/χ²值	0.240				0.233
P值	0.887				0.629

组别	完全缓解	部分缓解	病情稳定	疾病进展	疾病控制
同步放化疗组(n=42)	0(0)	6(14.29)	12(28.57)	24(57.14)	18(42.86)
靶向放化疗组(n=42)	0(0)	7(16.67)	22(52.38)	13(30.95)	29(69.05)
Z/χ²值	6.288				5.845
P值	0.043				0.016

组别	CA19-9(U/ml)		CA125(U/ml)		CEA(ng/ml)
组别	治疗前	治疗3个月	治疗前	治疗3个月	治疗前	治疗3个月
同步放化疗组(n=42)	56.82±10.12	29.34±3.69^a	47.46±5.97	21.63±2.69^a	16.28±2.24	6.19±1.23^a
靶向放化疗组(n=42)	56.66±10.28	16.27±2.13^a	47.12±5.88	13.25±2.26^a	16.78±2.12	2.97±0.85^a
t值	0.072	19.880	0.263	15.458	1.050	13.957
P值	0.943	<0.001	0.793	<0.001	0.297	<0.001

不良反应	同步放化疗组 (n=42)	靶向放化疗组 (n=42)
白细胞减少	3(7.14)	3(7.14)	<0.001	>0.999
中性线粒细胞减少	3(7.14)	4(9.52)	0.156	0.693
血小板减少	3(7.14)	3(7.14)	<0.001	>0.999
恶心、呕吐	1(2.38)	2(4.76)	0.346	0.556
合计	10(23.81)	12(28.64)	0.186	0.667