阿帕替尼治疗甲胎蛋白阳性晚期胃癌的临床观察

摘要

目的 观察阿帕替尼在甲胎蛋白(AFP)阳性晚期胃癌中的疗效和安全性.方法 收集本院2009年9月至2017年1月的AFP阳性胃癌患者7例,均接受阿帕替尼,联合或不联合全身化疗,阿帕替尼具体剂量为250～ 850 mg/d.分别采用RECIST 1.1版与NCI CTC 4.0版标准评价近期疗效和不良反应.采用Kaplan-Meier法进行生存分析.结果 7例患者均可评价疗效和安全性,获PR 1例、SD 3例和PD 3例,有效率为14.3％,疾病控制率为57.1％.中位无进展生存期为4个月(95％CI:0～9.1个月),中位总生存期为7个月(95％CI:5.7～8.3个月).7例患者中AFP下降5例.主要不良反应包括高血压、蛋白尿、血小板减少及粒细胞减少等,主要为1～3级.除1例出现3级高血压停止用药外,其他患者的不良反应可控,耐受性良好.结论 阿帕替尼治疗AFP阳性晚期胃癌疗效显著,不良反应可控、耐受性良好.%Objective To evaluate the efficacy and safety of apatinib in advanced alpha fetoprotein (AFP)-positive gastric cancer.Methods Seven patients with advanced AFP-positive gastric cancer from September 2009 to January 2017 received apatinib were enrolled.All the patients were given apatinib alone or in combination with chemotherapy,and the dose of apatinib was 250-850 mg/d.The efficacy and safety were evaluated by RECIST criteria (version 1.1) and NCI CTC 4.0 criteria.Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method.Results All patients were available for evaluation.Among the 7 patients,1 case got partial respond and 3 cases had stable disease.The response rate was 14.3％ and disease control rate was 57.1％.The median PFS was 4.0 months (95％CI:0-9.1) and the median OS was 7.0 months (95％CI:5.7-8.3).Among the 7 patients,the APF level decreased in 5 cases.The common treatment-related side effects included hypertension,proteinuria,thrombocytopenia and neutropenia,mainly in grade 1-3.Except one patient discontinued apatinib treatment due to grade 3 hypertension,the side effects were controlled and tolerated well in the other patients.Conclusion Apatinib is effective and tolerable in advanced AFP-positive gastric cancer.