甲磺酸阿帕替尼片治疗二线后晚期胃癌的疗效和安全性分析

Efficacy and safety of apatinib treatment for advanced stomach neoplasm

目的观察甲磺酸阿帕替尼片单药治疗二线后晚期胃癌的临床疗效和安全性。方法收集2015年10月至2017年4月山西省肿瘤医院收治的70例至少二线化学治疗失败后的晚期胃癌患者,口服甲磺酸阿帕替尼片,起始剂量:500 mg/d,服用2周后耐受良好的患者可酌情增加剂量至750~850 mg,4周为1个周期。治疗2个周期后,分析疗效及安全性。按照实体肿瘤疗效评价标准(RECIST 1.1)和美国国立癌症研究所不良反应事件通用术语标准评价疗效和不良反应。结果截止2017年11月2日,70例患者全部完成随访,中位无进展生存期4.03个月,中位总生存期6.23个月。部分缓解4例,疾病稳定42例,疾病进展24例,客观缓解率6%,疾病控制率为60%。不良反应多为1~2级,血液学毒性主要是白细胞减少、血小板减少、中性粒细胞减少和贫血;非血液学毒性主要是高血压、蛋白尿和手足综合征,以及乏力、腹痛、腹泻、声音嘶哑等。结论单药甲磺酸阿帕替尼片二线后治疗晚期胃癌仍有一定的疾病控制率,不良反应可控、可预测,安全性良好,生活质量较高,值得临床推广。

Objective Toobserve efficacy and safety of Apatinib treatment for advanced gastric cancer. Methods All70 cases with advanced gastric cancer who were admitted to Shanxi Tumor Hospital from October 2015 to April 2017.The initial dose of Apatinib were 500 mg/daily,and 4 weeks as a cycle. The investigators consider patients who with good tolerability increasing doses 750-850 mg after 3 weeks. After 2 cycles of treatment,the investigators analyzed the efficacy and safety. Efficacy and adverse effects were evaluated according to the standard of efficacy evaluation for solid tumors（RECIST 1.1）and the National Cancer Institute general terminology criteria for adverse events. Results All 70 cases completed follow-up by November 2,2017.The median progression free survival was 4.03 months,and the median overall survival was 6.23 months. Among them,4 cases were partial response,42 cases were stable,24 cases were disease progression,the objective remission rate was 5.71% and the disease control rate was 60%. The adverse reactions were mostly grade 1-2. Hematologic toxicity mainly includes white blood cell reduction,thrombocytopenia,neutropenia and anemia. Non hematologic toxicity mainly includes hypertension,proteinuria and hand foot syndrome,weakness abdominal pain,diarrhea. Conclusion Apatinib monotherapy in the treatment of advanced gastric cancer is still a good disease control rate,adverse reactions can be controlled and predicted,it is worthy of clinical promotion.