阿帕替尼联合SOX方案对胃癌伴腹膜转移患者进行转化治疗的临床疗效

Transforming therapeutic efficacy of apatinib combined with SOX regimen in the treatment of gastric cancer with peritoneal metastasis

目的验证阿帕替尼联合奥沙利铂+替吉奥(SOX)方案在晚期胃癌伴腹膜转移患者中的转化治疗疗效。方法采用描述性病例系列研究方法,收集2016年3月至2021年8月在浙江省人民医院以及树兰(杭州)医院就诊的胃癌伴腹膜转移患者资料,予以阿帕替尼联合SOX方案治疗。奥沙利铂130 mg/m^(2),静脉滴注,第1天;甲磺酸阿帕替尼片500 mg/d,口服,1次/d,第1~21天;替吉奥:根据体表面积计算给药量(<1.25 m^(2)者40 mg;1.25~1.50 m^(2)者50 mg;>1.50 m^(2)者60 mg),口服,2次/d,第1~14天。自化疗第1天起,以3周为1个周期。每2个周期后进行近期疗效评价。之后由多学科治疗团队决定是否可接受转化手术,符合手术切除要求时停药1周期后即进行手术。结果23例患者的中位生存时间(MST)为14.1个月(95%CI:12.3~16.4);转化治疗后的中位总生存时间(OS)为19.1个月(95%CI:15.5~22.8)。经转化治疗后,23例患者中14例部分缓解(PR)、3例疾病稳定(SD)和6例疾病进展(PD),客观缓解率(ORR)为73.9%(17/23)。12例(52.2%)患者经转化治疗后行手术治疗,12例接受手术的患者生存时间为(17.0±1.5)个月;其中5例行R0切除,R0切除率5/12。结论晚期胃癌伴腹膜转移患者采用阿帕替尼联合SOX方案的转化治疗,可获得较高的R0切除率,转化效果良好。

Objective To verify the transforming therapeutic efficacy of apatinib combined with oxaliplatin+tegiol(SOX regimen)in advanced gastric cancer with peritoneal metastasis.Methods Using the method of descriptive case series study,the data of gastric cancer patients with peritoneal metastasis treated in Zhejiang Provincial People′s Hospital and Shulan(Hangzhou)Hospital from March 2016 to August 2021 were collected and treated with apatinib combined with SOX regimen.Oxaliplatin 130 mg/m^(2),intravenous drip,day 1;Apatinib mesylate tablets 500 mg/d,oral,once a day,1-21 days;Teggio:calculate the dosage according to the body surface area(<1.25 m^(2),40 mg;1.25-1.50 m^(2),50 mg;>1.50 m^(2),60 mg).Take it orally for 1-14 days,twice a day.From the first day of chemotherapy,a cycle of 3 weeks.The short-term efficacy was evaluated every 2 cycles.After that,the multidisciplinary treatment team will decide whether the conversion operation can be accepted.When the requirements of surgical resection were met,the operation will be carried out after 1 cycle of drug withdrawal.Results The median survival time(MST)of 23 patients was 14.1 months(95%CI:12.3-16.4);The median overall survival(OS)after transformation therapy was 19.1 months(95%CI:15.5-22.8).After transformation therapy,14 cases of partial remission(PR),3 cases of stable disease(SD)and 6 cases of progression disease(PD)in 23 patients,and the objective remission rate(ORR)was 73.9%(17/23).12(52.2%)patients underwent surgery after transformation therapy.The 1-year OS of 12 patients was(17.0±1.5)months;Among them,5 cases underwent R0 resection,and the R0 resection rate was 5/12.Conclusions Transformation treatment with apatinib combined with oxaliplatin+tegio(SOX regimen)in advanced gastric cancer can achieve a high R0 resection rate with better conversion effect.