Abstract:

Objective To explore the clinical efficacy and safety of the camrelizumab combined with apatinib and chemotherapy as second-line or later therapy in human epidermal growth factor receptor-2 （HER-2） negative advanced gastric cancer. Methods A total of 66 patients with HER-2 negative advanced gastric cancer and first-line treatment failure in Shandong Cancer Hospital Affiliated to Shandong First Medical University from March 2018 to September 2021 were selected. They were divided into study group （n=22） and control group （n=44） according to the different treatment regimens. The patients in the study group were treated with camrelizumab combined with apatinib and chemotherapy, and the patients in the control group were treated with chemotherapy alone. The short-term efficacy, progression-free survival （PFS）, overall survival （OS） and the occurrence of adverse reactions were compared, and Cox regression analysis was used to analyze the influencing factors of prognosis. Results After at least 2-4 cycles of treatment, the ORR in the study group and the control group were 9.1% （2/22） and 0 （0/44） respectively, with no statistically significant difference （P=0.108）. DCR in the two groups were 77.3% （17/22） and 45.5% （20/44） respectively, with a statistically significant difference （χ²=6.03, P=0.014）. The study group didn’t reach median OS and the median OS in the control group was 11.7 months, with no statistically significant difference （χ²=1.59, P=0.207）. The study group didn’t reach median PFS and the median PFS in the control group was 3.2 months, with a statistically significant difference （χ²=10.13, P=0.001）. Multivariate Cox regression analysis showed that treatment method was an independent influencing factor for PFS in patients with HER-2 negative advanced gastric cancer （HR=0.33, 95%CI： 0.15-0.75, P=0.008）. In terms of adverse reactions, there was a statistically significant difference in the incidence of elevated alanine aminotransferase between the study group and the control group [31.8% （7/22） vs. 6.8% （3/44）, χ²=5.32, P=0.021]. There were no adverse-related deaths in both groups. Conclusion Compared with chemotherapy alone, camrelizumab combined with apatinib and chemotherapy as a second-line or later therapy in HER-2 negative advanced gastric cancer can prolong PFS and improve DCR, but the incidence of elevated alanine aminotransferase increases significantly.

Key words: Stomach neoplasms, Drug therapy,combination, Camrelizumab, Apatinib