Apatinib, S-1 plus oxaliplatin treats locally advanced gastric cancer effectively, safely
In the treatment of locally advanced gastric cancer, apatinib combined with S-1 plus oxaliplatin was a safe and effective neoadjuvant treatment, according to a nonrandomized controlled study.
“Neoadjuvant chemotherapy could decrease the tumor stage, increase the R0 resection rate and provide survival benefits for patients with advanced GC,” Jian-Xian Lin, MD, PhD, Fujian Medical University Union Hospital, and colleagues wrote. “However, rare evidence supports the use of apatinib combined with chemotherapy in neoadjuvant treatment.”
Between July 1, 2017, and June 30, 2019, Lin and colleagues studied 48 patients with primary gastric adenocarcinoma (37 men, 77.1%) aged 18 years to 75 years across 10 centers in southern China. Participants had M0 and either T2 to T4 or N+ disease and no previous surgery, chemotherapy, radiotherapy or targeted therapy.
Patients received treatment every 3 weeks with two to five preoperative and six postoperative cycles of apatinib and S-1 plus oxaliplatin (SOX). Good tumor response elicited surgery 2 weeks to 4 weeks after treatment; poor tumor response elicited two more courses of treatment followed by evaluation for surgical candidacy. Outcomes were R0 resection rate, response rate, toxic effects and surgical outcome.
Forty participants underwent surgery, 36 of whom had radical gastrectomies with an R0 resection rate of 75% (36 of 48 patients; 95% CI, 60.4-86.4). Investigators observed pathological response rate in 26 patients (54.2%; 95% CI, 39.2-68.6), major pathological response in 12 (25%; 95% CI, 13.6-39.6) and complete pathological response in three (6.3%; 95% CI, 1.3-17.2).
“The pathological response rate was 80% (12 of 15 patients) and the major pathological response rate was 33.3% (5 of 15 patients) among those who achieved a radiologic response, suggesting that the pathological response did not always agree with the radiologic response,” Lin and colleagues said.
Results revealed toxic effects and surgical complications were manageable, and drug-related or postoperative deaths did not occur.
Limitations included potential selection bias and a small sample size. Moving forward, the researchers suggested a large, multicenter, randomized clinical trial could confirm the safety and efficacy of apatinib plus SOX in treating locally advanced gastric cancer.
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