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Home All Specialties Chronic Disease

Neoadjuvant apatinib therapy for locally advanced gastric cancer associated with high R0 resection rate

byJake EngelandMichael Pratte
July 14, 2021
in Chronic Disease, Gastroenterology, Surgery
Reading Time: 2 mins read
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1. Neoadjuvant treatment of apatinib combined with S-1 plus oxaliplatin (SOX) was shown to be an effective treatment modality, resulting in a 75% R0 resection rate in patients with locally advanced gastric cancer.

2. Apatinib demonstrated a satisfactory safety profile, with no grade 4 adverse events or death from apatinib plus SOX therapy in this study.

Evidence Rating Level: 2 (Good)

Study Rundown: Locally advanced gastric cancer (GC) has been shown to respond poorly to chemotherapy. High vascular endothelial growth factor (VEGF) expression is a feature of many gastric tumours. Apatinib, a selective inhibitor of vascular endothelial growth factor receptor 2 (VEGFR2), may be an effective treatment option for locally advanced GC. This phase 2 trial investigated whether apatinib combined with S-1 plus oxaliplatin (SOX) is an effective and safe treatment for locally advanced GC. Participants (48 patients; mean [SD] age: 63.2 [8.2] years) in this study were recruited from 10 centres in Southern China and were included if they had primary gastric adenocarcinoma with no previous treatment or distant metastases. Participants underwent 2-5 preoperative cycles of apatinib plus SOX every three weeks followed by a gastrectomy. The primary outcome was the R0 resection rate (proportion of patients with margin-free resection); secondary outcomes were response rate, toxic effects, and surgical outcome. Forty out of forty-eight patients underwent surgery. R0 resection rate of the enrolled population was 75% (95% CI: 60.4-86.4; 36/48 patients) and of those who underwent surgery was 90% (95% CI: 76.3-97.2; 36/40 patients). A radiologic response was observed in 75% of patients. A pathological response (grade Ib or better) was observed in 26/48 patients (54.2% [95% CI: 39.2-68.6%]), including a complete pathological response in 3/48 patients (6.3% [95% CI: 1.3-17.2]). The most common adverse effects were hematologic. Sixteen patients (33%) suffered from grade 3 adverse events, and there were no grade 4 adverse events or preoperative deaths. Overall, this trial demonstrated that the neoadjuvant treatment for locally advanced GC of apatinib and SOX was effective with a reasonable safety profile. Notably, this trial was nonrandomized (no control group), and the sample size was small. A large, randomized control trial is required to verify the effectiveness and safety of this therapy regimen.

Click to read the study in JAMA Network Open

Relevant Reading: Randomized, double-blind, placebo-controlled phase III trial of apatinib in patients with chemotherapy-refractory advanced or metastatic adenocarcinoma of the stomach or gastroesophageal junction

Image: PD

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