Abstract:

Objective To evaluate the efficacy and safety of apatinib and S-1 on advanced gastric cancer as second-line and above treatment in order to provide reference for clinical medication. Methods  The pertinent randomized controlled trials （RCTs） about apatinib group and S-1 group as second-line and above treatment for advanced gastric cancer. Studies were retrieved from Cochrane Library， Pubmed， CNKI and Wanfang Database from inception to December 2017. The quality of included studies was evaluated according to modified Jadad scale. Then the related data was extracted and meta-analysis was performed by using Rev Man 5.3 statistical software. Results A total of 8 RCTs were included，involving 456 patients. The Results  of meta-analysis showed that the Objective  response rate was significantly improved in apatinib group compared with S-1 group （RD=0.12， 95％CI： 0.03-0.20， P=0.008）. The disease control rate （RD=0.05， 95％CI：-0.03-0.13， P=0.23） and the quality of life （RD=0.11， 95％CI：-0.00-0.22， P=0.22） had no difference between the two groups. The incidence of hypertension was increased in apatinib group compared with S-1 group （OR=15.27， 95％CI： 2.79-83.76， P=0.002）. However， nausea and vomiting was decreased with statistically significant difference in apatinib group （OR=0.38， 95％CI： 0.18-0.82， P=0.01）. The occurrence of proteinuria， neutropenia， hand-foot syndrome and other adverse reaction had no difference between the two groups. Conclusion Apatinib can improve overall response rate more effectively compared with S-1 as second-line and above treatment for advanced gastric cancer. Meanwhile， the adverse reactions of apatinib were comparable to S-1.

Key words: Gastric cancer, Apatinib, S-1, Efficacy, Safety, Meta-analysis