Abstract:
Objective To evaluate the short-term efficacy and side effects of apatinib administered alone or in combination with chemotherapy for the treatment of metastatic colorectal cancer.
Methods The medical records of 23 cases with metastatic colorectal carcinoma, who were treated at Tangshan People's Hospital from January 2016 to December 2017, were retrospectively reviewed. The diagnoses of all the patients were confirmed by microscopy or surgery reports. First-or second-line chemotherapy was administered on the basis of the diagnosis and treatment guidelines for colorectal cancer. After progressive disease was noted in the condition, apatinib was administered as a single drug or in combination with chemotherapy. Sixteen patients received apatinib alone and 7 received apatinib combined with chemotherapy. The dose of apatinib varied from 250 mg to 500 mg. Computed tomography was performed to evaluate the treatment efficacy monthly in the first 3 months, and every 3 months after that. The efficacy and toxicity of apatinib were also evaluated in this study. The Kaplan-Meier method was used to calculate the overall survival rate. The Cox regression model was used for multivariate prognostic analysis.
Results Analyzing all patients as one group, none of them achieved complete response (CR), 9 of them achieved partial response (PR), 7 cases had stable disease (SD) and 7 cases had progressive disease (PD), overall response rate (ORR) was 39.13%, disease control rate (DCR) was 69.56%, progression-free survival (PFS) ranged from 1 to 19 months, and median PFS was 5 months. In the apatinib group, there were 0 cases of CR, 5 cases of PR, 5 cases of SD, 6 cases of PD, ORR was 31.25%, DCR was 62.5%, and median PFS was 4.5 months. In the apatinib combined chemotherapy group, there were 0 cases of CR, 4 cases of PR, 2 cases of SD and 1 case of PD, with ORR of 57.1%, DCR of 85.7% and median PFS of 12.0 months. Concurrent chemotherapy, apatinib dose, lactate dehydrogenase elevation, hypoalbuminemia, and efficacy evaluation were the main factors contributing to patients' PFS (P < 0.05, respectively). Cox regression multivariate analysis showed that lactate dehydrogenase elevation was an independent factor of PFS. Single-factor analysis of Log-rank test showed that concurrent chemotherapy, apatinib dose, hemoglobin reduction, CD4+ lympho-cyte decline, and therapeutic effect evaluation were correlated with overall survival (P < 0.05, respectively). Cox regression multivariate analysis also showed that there was no statistical significance with respect to overall survival. The toxicity and side effects of the two groups were mainly mild hypertension, proteinuria, and hand-foot syndrome, with no statistical difference.
Conclusions Apatinib combined with chemotherapy can improve PFS of metastatic colorectal cancer patients with failed chemotherapy, and can be used as an effective method for the treatment of metastatic colorectal cancer.