Neoadjuvant apatinib plus tegafur/gimeracil/oteracil potassium (S‑1)/oxaliplatin chemotherapy vs. chemotherapy alone in patients with locally advanced gastric carcinoma

Abstract

The current study aimed to evaluate the efficacy and safety of neoadjuvant apatinib plus tegafur/gimeracil/oteracil potassium (S-1) plus oxaliplatin (SOX) chemotherapy in patients with locally advanced gastric carcinoma (LAGC). Therefore, patients with LAGC treated with neoadjuvant apatinib plus SOX chemotherapy (apatinib + SOX group; n=25) or SOX chemotherapy (SOX group; n=35) were enrolled in the present study. Subsequently, the objective response (ORR) and disease control rates (DCR), pathological response, disease-free survival (DFS), overall survival (OS) and adverse events were recorded. The results showed that patients in the apatinib + SOX group exhibited a higher ORR (64.0 vs. 37.1%; P=0.040), but a similar DCR (96.0 vs. 88.6%; P=0.580), compared with those in the SOX group. The pathological response rates in patients with grade 0, 1, 2 and 3 LAGC were 0.0, 20.8, 62.5 and 16.7%, respectively, in the apatinib + SOX group, while in those treated with SOX alone they were 9.1, 39.4, 42.4 and 9.1%, respectively. By contrast, the pathological response was elevated in the apatinib + SOX group compared with the SOX group (P=0.030). During a median follow-up period of 21.0 months (range, 6.4-38.1 months), median DFS and OS were not reached. More specifically, the 1-, 2-and 3-year DFS rates were 91.7, 75.2 and 75.2% in the apatinib + SOX group and 71.8, 59.6 and 44.7% in the SOX group, respectively. In addition, the 1-, 2-and 3-year OS rates were 100.0, 89.6 and 78.4% in the apatinib + SOX group, while those in the SOX group were 90.3, 69.2 and 55.4%, respectively. However, no differences in DFS (P=0.094) or OS (P=0.155) were observed between the two groups. Additionally, the most common adverse events in the SOX group were mild leukopenia (42.9%) and fatigue (34.3%), while those in the apatinib + SOX group were tolerable leukopenia (44.0%) and hypertension (44.0%). In conclusion, the present study suggested that neoadjuvant apatinib plus SOX chemotherapy could be more effective and tolerable compared with SOX chemotherapy alone in patients with LAGC.

Safety and Efficacy of of apatinib combined with chemotherapy in the second-line and subsequent lines of advanced gastric cancer: A systematic review and meta-analysis

“…We searched 1594 studies from 7 databases.Of these studies, 826 duplicate studies were excluded and two reviewers independently assessed the remaining 768 studies to determine their eligibility.Next, a total of 752 studies were excluded due to the following reasons: no control group (286); insu cient data (98); full text unavailable (143); quality assessment exclusion (139); combined PD-1/PD-L1 ( 89).Finally, a total of 13 studies were included [17-29] [17][18][19][20][21][22][23][24][25][26][27][28][29] .The detailed literature search process is shown in Fig. 1.…”

“…To the best of our knowledge, this is the rst and most comprehensive meta-analysis of apatinib combined with chemotherapy in the treatment of primary intermediate and advanced GC.We included 13 studies [17][18][19][20][21][22][23][24][25][26][27][28][29] with a total of 1217 cases, all of which were assessed as high-quality studies.The results of this study showed that in terms of e cacy, the ORR, R0 resection rate, and DCR of the observation group were better than those of the control group and were statistically signi cant.In addition to clinical e cacy, we analyzed the adverse events caused by apatinib.Speci c adverse events include: hypertension, anemia,thrombocytopenia,leukopenia,and diarrhea.Hypertension, hand-foot syndrome, and diarrhea in the observation group were higher than those in the control group and were statistically signi cant, which is consistent with the study by Xinyang Liu et al [30] .However, there were no signi cant differences in other adverse events between the two groups.Taken together, apatinib combined with chemotherapy can improve the e cacy of patients with advanced GC and has good safety.GC is a highly aggressive malignant tumor.Most patients are diagnosed at an advanced stage and often show symptoms such as distant lymphatic metastasis and pelvic metastasis.For these patients, systemic chemotherapy is the main treatment option [31] .Depending on human epidermal growth factor receptor 2 status, various combination regimens of uoropyrimidine and platinum with/without trastuzumab are commonly used as rst-line chemotherapy [32] .During or after rst-line chemotherapy for advanced GC, the disease Progressive symptoms often develop rapidly with associated deterioration in performance status, making patients unsuitable for systemic therapy [33] .Ramucirumab as a single agent or in combination with paclitaxel (preferred) is a category 1 recommendation for second-line treatment [34] can signi cantly improve PFS and OS in GC patients after rst-line treatment, either as monotherapy (REGARD [35] ) or in combination with paclitaxel (RAINBOW [36] ) [37] .However, regardless of the effectiveness of any currently available chemotherapy Regardless of the positive impact, the prognosis for patients with advanced GC remains hopeless, with a median survival of only 7-10 months in most large studies [31] .In recent years, with the development and progress of medicine, molecular targeted drug therapy has become a hot spot in clinical research, providing a new way to treat GC.The study by Caiyun Nie et al…”

“…1 item [17] is unknown.There are 8 studies using RCT [17, 18, 20-22, 24, 28, 29] .There are 5 studies using retrospective research [19,23,[25][26][27] [19,23,[25][26][27] .According to the NOS scale, Yonglei Zhang 2021 [19] , Qiuju Wu 2019 [23] , Fengli Zhang 2020 [25] , Caiyun Nie 2023 [26] , Dan Hong 2021 [27] scored 8 points, 9 points, 8 points, 9 points, and 7 points respectively.More details of the quality evaluation are shown in Fig. 2.Based on the Cochrane risk of bias tool Bin Lu 2019 [17] , HF.Wang 2023 [18] , Zhengfeng Wang 2022 [21] , Min Yuan 2021 [22] , Sun Yun 2022 [24] , Shen Gao 2022 [29] , Yesong Guo 2018 [28] was assessed as low risk, and Pengzhe Zhou 2021 [20] was assessed as medium risk.The quality evaluation results are shown in Fig. 3.…”

“…In 13 documents [17][18][19][20][21][22][23][24][25][26][27][28][29] ,, a total of 345 patients reported the ORR of treatment.The ORR of the observation group was better than that of the control group (OR = 2.49, 95% CI = 1.86-3.34).Heterogeneity analysis showed that there was no signi cant heterogeneity between studies (I2 = 14%, p = 0.304), and a metaanalysis effect model was used (Fig. 4).…”

“…Thirteen included studies [17][18][19][20][21][22][23][24][25][26][27][28][29] reported DCR, involving a total of 780 patients. The results showed that the DCR of the observation group was also better than that of the control group (OR = 2.78, 95% CI = 2.11-3.66).Heterogeneity analysis showed that heterogeneity between studies using the xed effects model was low (I2 = 0.0%, p = 0.842) (Fig.…”