Abstract:

Objective To observe the clinical efficacy and adverse reactions of apatinib combined with albumin-bound paclitaxel in elderly patients with relapsed and metastatic gastric cancer. Methods A total of 72 elderly patients with relapsed and metastatic gastric cancer diagnosed in the Department of Oncology, West District of the First Affiliated Hospital of University of Science & Technology of China from June 1, 2017 to June 1, 2019 were chosen. The patients were divided into control group (n=36) and study group (n=36) using random number table method. The control group received only albumin-bound paclitaxel chemotherapy, and the study group continued oral apatinib based on the control group's chemotherapy, every 3 weeks for one chemotherapy cycle, a total of 4 cycles. The short-term efficacy, median overall survival (OS), median progression-free survival (PFS), serum carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), carbohydrate antigen 72-4 (CA72-4) and adverse reactions were compared between the two groups. Results The objective response rate and disease control rate of the study group were 55.56% (20/36) and 77.78% (28/36) respectively, which were higher than those of the control group [30.56% (11/36) and 55.56% (20/36)], and there were statistically significant differences (χ²=4.589, P=0.032; χ²=4.000, P=0.046). After 4 cycles treatment, the serum CEA, CA199 and CA72-4 levels in the study group were (12.5±3.3) μg/L, (35.6±6.7) U/ml, (13.5±2.2) U/ml respectively, which were lower than those in the control group [(22.8±4.1) μg/L, (55.6±7.4) U/ml, (21.7±3.4) U/ml], and there were statistically significant differences (t=7.008, P=0.017; t=9.365, P=0.008; t=8.862, P=0.011). The incidences of gastrointestinal reactions and myelosuppression were 38.89% (14/36) and 44.44% (16/36) in the study group, and 36.11% (13/36) and 41.67% (15/36) in the control group respectively, with no significant differences (χ²=0.059, P=0.808; χ²=0.057, P=0.811). The incidences of hypertension, hand-foot syndrome, oral mucositis and proteinuria in the study group were 27.78% (10/36), 41.67% (15/36), 27.78% (10/36) and 16.67% (6/36) respectively, which were higher than those in the control group [8.33% (3/36), 16.67% (6/36), 5.56% (2/36) and 2.78% (1/36)], and there were statistically significant differences (χ²=4.600, P=0.032; χ²=5.445, P=0.020; χ²=6.400, P=0.011; χ²=3.956, P=0.047), which could be tolerated after symptomatic treatment. The median OS and PFS of the study group were 18.2 months and 16.1 months, which were longer than those of the control group (11.8 months and 8.0 months), and there were statistically significant differences (χ²=6.821, P=0.015; χ²=5.868, P=0.018). Conclusion Apatinib combined with albumin-bound paclitaxel is superior to albumin-bound paclitaxel single-agent chemotherapy in elderly patients with relapsed and metastatic gastric cancer, which can prolong the PFS and OS, and the adverse reactions are tolerable.

Key words: Stomach neoplasms, Albumin-bound paclitaxel, Neoplasm metastasis, Recurrence, Apatinib