Efficacy and prediction of different doses of apatinib combined with SIB-IMRT in elderly patients with locally recurrent esophageal cancer

Abstract:

Objective：To explore the clinical efficacy of different doses of apatinib combined with simultaneous integrated boost intensity-modulated radiation therapy（SIB-IMRT） in elderly patients with locally recurrent esophageal cancer，and its correlation with serum vascular endothelial cell growth factor receptor-2（VEGFR-2） and basic fibroblast growth factor（bFGF）. Methods：A total of 126 elderly patients with locally recurrent esophageal cancer admitted to the Department of Radiotherapy of Zhangye People’s Hospital Affiliated to Hexi University from January 2017 to January 2019 were randomly divided into the S-1 group，the apatinib group（0.25 g），and the apatinib group（0.5 g），with 42 patients in each group. All patients were given SIB-IMRT on a locally recurrent lesion of esophageal cancer，and the corresponding drug was given on the first day of radiotherapy. Primary study endpoints：progression-free survival（PFS），overall survival（OS）；secondary study endpoints：objective response rate（ORR），disease control rate（DCR），changes in serum markers VEGFR-2 and bFGF，and incidence of adverse drug reactions. Results：One patient in the apatinib group（0.5 g） dropped out of the clinical trial due to intolerance of hypertension. Compared with the S-1 group，the ORR and DCR of the apatinib group（0.25 g） and the apatinib group（0.5 g） were significantly increased（P<0.05），the levels of serum VEGFR-2 and bFGF were significantly decreased（P<0.05），the incidence of myelosuppression，gastrointestinal reactions，and fatigue decreased significantly（P<0.05），the incidence of adverse reactions to hypertension，hand-foot syndrome，proteinuria，and oral mucosal reactions significantly increased（P<0.05），and PFS and OS were significantly prolonged（P<0.05）. The differences were statistically significant. The incidence of fatigue，hypertension，hand-foot syndrome，and oral mucosal reactions in the apatinib group（0.5 g） was significantly higher than that in the apatinib group（0.25 g）（P<0.05），with statistical significance. There was no significant difference in the ORR，DCR，VEGFR-2，bFGF-6，OS，and other indicators between the apatinib group（0.5 g） and the apatinib group（0.25 g）（P >0.05）. Conclusion：Compared with the S-1 group，low-dose apatinib（0.25 g） combined with SIB-IMRT can improve survival and safety of elderly patients with locally recurrent esophageal cancer. Serum markers VEGFR-2 and bFGF may be potential markers for predicting therapeutic efficacy.