Objective:   To investigate the safety and efficacy of fluorouracil-based two-drug combination chemotherapy with apatinib, as a conversion therapy, in patients with unresectable gastric cancer (GC).

  Methods:   A retrospective analysis of 33 patients with unresectable stage Ⅳ GC receiving conversion therapy at Tianjin Medical University Cancer Institute and Hospital between March 2017 and June 2018, was performed. Patients with peritoneal or ovarian metastasis received S1/paclitaxel (PTX)/apatinib (S1:60 mg, bid, days 1-14; PTX:50 mg/m² iv, days 1 and 8; PTX:20 mg/m² ip, days 1 and 8; q3w; apatinib 500 mg po, qd). Patients with other non-curable factors were administered a regimen of SOX plus apatinib (oxaliplatin 130 mg/m², S1:60 mg, bid, days 1-14; apatinib 500 mg po, qd). Apatinib should be withdrawn from the last cycle before surgery. Surgery should be performed after MDT.

  Results:   After at least three cycles chemotherapy, 21 patients achieved partial response (PR)and 8 patients had progressive disease (PD), resulting in an objective response rate of 75.7%. Surgery was performed on 22 patients with PR, and 21 patients (63.6%) achieved R0 resection; the number of excised lymph nodes was 57.0±15.6, intraoperative hemorrhage was (164±46) mL, the operation time was (212.0±44.8) min, and the postoperative hospital stay was (13.0 ±2.7) days. Patients who had surgery had a median progression free survival (mPFS) of 10.5 months and an median overall survival (mOS)of 16.5 months; for patients who did not undergo surgery, the median progression free survival (mPFS)was 2.5 months and mOS was 5.5 months.

  Conclusions:   As a conversion therapy, fluorouracil-based two drug-combination chemotherapy with apatinib provided a high R0 resection rate for unresectable stage Ⅳ GC, with an acceptable safety profile.