Apatinib for chemotherapy-refractory advanced metastatic gastric cancer: results from a randomized, placebo-controlled, parallel-arm, phase II trial.

Abstract

PURPOSE:

Patients with metastatic gastric cancer (mGC) who do not respond to or who experience progression with second-line chemotherapy have no treatment options that clearly confer a survival benefit. This trial investigated the safety and efficacy of apatinib, an inhibitor of vascular endothelial growth factor receptor, as a treatment option for heavily pretreated patients with mGC.

PATIENTS AND METHODS:

Patients who experienced treatment failure with at least two chemotherapeutic regimens were randomly assigned to receive placebo (group A), apatinib 850 mg once daily (group B), or apatinib 425 mg twice daily (group C).

RESULTS:

We enrolled 144 patients onto this study. In groups A, B, and C, the median overall survival (OS) times were 2.50 months (95% CI, 1.87 to 3.70 months), 4.83 months (95% CI, 4.03 to 5.97 months), and 4.27 months (95% CI, 3.83 to 4.77 months), respectively, and the median progression-free survival (PFS) times were 1.40 months (95% CI, 1.20 to 1.83 months), 3.67 months (95% CI, 2.17 to 6.80 months), and 3.20 months (95% CI, 2.37 to 4.53 months), respectively. There were statistically significant differences between the apatinib and placebo groups for both PFS (P < .001) and OS (P < .001 and P = .0017). Nine patients had a partial response (three patients in group B and six patients in group C). Toxicities were tolerable or could be clinically managed. The most common grade 3 to 4 adverse events were hand-foot syndrome and hypertension. Hematologic toxicities were moderate, and grade 3 to 4 hematologic toxicities were rare.

CONCLUSION:

Apatinib showed improved PFS and OS in heavily pretreated patients with mGC who had experienced treatment failure with two or more chemotherapy regimens.

• Authors: Jin Li, Shukui Qin, Jianming Xu, Weijian Guo, Jianping Xiong, Yuxian Bai, Guoping Sun, Yan Yang, Liwei Wang, Nong Xu, Ying Cheng, Zhehai Wang, Leizhen Zheng, Min Tao, Xiaodong Zhu, Dongmei Ji, Xin Liu, Hao Yu
• Journal: Journal of clinical oncology : official journal of the American Society of Clinical Oncology (J Clin Oncol) Vol. 31 Issue 26 Pg. 3219-25 (Sep 10 2013) ISSN: 1527-7755 [Electronic] United States
• PMID: 23918952 (Publication Type: Clinical Trial, Phase II, Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Pyridines
• apatinib

Topics

• Adolescent
• Adult
• Aged
• Double-Blind Method
• Drug Resistance, Neoplasm (drug effects)
• Female
• Follow-Up Studies
• Humans
• International Agencies
• Liver Neoplasms (drug therapy, mortality, secondary)
• Lung Neoplasms (drug therapy, mortality, secondary)
• Male
• Middle Aged
• Neoplasm Recurrence, Local (drug therapy, mortality)
• Neoplasm Staging
• Peritoneal Neoplasms (drug therapy, mortality, secondary)
• Prognosis
• Pyridines (therapeutic use)
• Stomach Neoplasms (drug therapy, mortality, pathology)
• Survival Rate
• Young Adult