The efficacy and safety of apatinib for refractory malignancies: a review and meta-analysis
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Background and purpose: Apatinib is a novel, oral, small-molecule tyrosine kinase inhibitor that targets VEGFR-2. Recent clinical trials have revealed its broad-spectrum anticancer effect. However, most recent studies of apatinib have involved single-arm studies with insufficient cases, different doses of drugs, and different incidences of adverse events (AEs), which has resulted in a lack of accurate measurement of the efficacy and safety of apatinib. Thus, we performed this meta-analysis to evaluate the efficacy and safety of apatinib. Methods: In total, 21 studies from five databases (PubMed, ScienceDirect, ClinicalTrials.gov , China National Knowledge Infrastructure [CNKI], and Cochrane Library) were included in this meta-analysis. All statistical analyses in this meta-analysis were performed using Stata 14.0 software. We used objective response rate (ORR) and disease control rate (DCR) to evaluate the efficacy of apatinib for five major types of solid tumors. Additionally, we used the total incidence of AEs and the incidence of the three most common grade 3–4 AEs to evaluate the safety of apatinib. Results: The pooled results for the efficacy of apatinib in the treatment of different types of solid tumors revealed that patients treated with apatinib exhibited good disease control. In addition, it was likely that an increased dose of apatinib resulted in an increased ORR in lung and breast cancer and an increased DCR in liver and gastric cancer. Although AEs appeared in 84% of patients included in this meta-analysis, most of these AEs were of grades 1–2 and were well tolerated and controlled. The most common grade 3–4 AEs included hypertension, hand-foot syndrome, and proteinuria. Importantly, there were no significant differences in these grade 3–4 AEs with higher doses of apatinib. Conclusion: Apatinib is a novel VEGFR-2 inhibitor with proven efficacy and safety for solid tumors. The meta-analysis reveals the broad-spectrum anticancer effect of apatinib. Keywords: apatinib, solid tumors, objective response rate, disease control rate, adverse eventsKeywords:
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Apatinib is a novel tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, which has been proved to be effective and safe in treating heavily pretreated patients with gastric cancer. The aim of the study was to explore the use of apatinib in treatment of nonsmall cell lung cancer and its side effects. We report 2 patients presented with advanced nonsmall-cell lung cancer, who received apatinib after failure in the first- or third-line chemotherapy. They are treated with apatinib in daily dose of 850 mg, 28 days per cycle. Favorable oncologic outcomes were achieved in the 2 cases after the treatment of apatinib. Patient I's progression-free-survival has increased to 4.6 months after palliative therapy of apatinib, whereas Patient II nearly 6 months. The common side effects of apatinib were hypertension and hand-foot syndrome; however, the toxicity of apatinib was controllable and tolerable. Apatinib may be an option for advanced nonsmall cell lung cancer after failure of chemotherapy or other targeted therapy. But that still warrants further investigation in the prospective study.
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Background. In recent years, traditional Chinese exercises (TCEs) have been gradually used to reduce the blood pressure levels of patients with essential hypertension. However, there are several types of TCEs, and there is no comparative study on the antihypertensive effects of various TCEs in patients with essential hypertension. Objective. The objective is to compare the therapeutic effects of Taijiquan (TJQ), Baduanjin (BDJ), Wuqinxi (WQX), and Yijinjing (YJJ) on essential hypertension and provide a reference for clinical treatment and scheme optimization. Methods. The China National Knowledge Infrastructure (CNKI), Wanfang, China Scientific Journal Database, China Biology Medicine database (CBM), PubMed, Embase, Cochrane Library, and Web of Science databases were searched to collect all randomized controlled trials (RCTs) of TCEs in the treatment of essential hypertension. The search time was from the establishment of each database to November 2021. After data extraction and quality evaluation, the network meta-analysis was performed with Stata 16.0 and ADDIS 1.16.8. Results. Finally, 45 RCTs involving 3864 patients were included. Network meta-analysis showed that YJJ had the best effect in reducing systolic blood pressure, and the difference was statistically significant [MD = −14.27, 95% CI = (−20.53∼−8.08), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). In terms of reducing diastolic blood pressure, the treatment effect of YJJ was the best, and the difference was statistically significant [MD = −7.77, 95% CI (−12.19∼−3.33), ]. The best probability ranking was YJJ ( ) > TJQ ( ) > WQX ( ) > BDJ ( ). Conclusion. The results showed that TCEs significantly reduced systolic and diastolic blood pressure compared with the control group, and YJJ might be the best choice. However, a larger sample, multicenter, double-blinded, high-quality RCTs are needed to make clear conclusions.
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Results of published studies on the association between the miR-146a rs2910164 polymorphism and the risk of hepatocellular carcinoma (HCC) were inclusive. We performed a meta-analysis. A literature research was conducted using PubMed, Cochrane Library, Ovid, Embase, Wanfang and China National Knowledge Infrastructure (CNKI) databases, to identify studies. Statistical analyses were conducted in STATA version 11.0 (Stata Corporation, College station, TX, USA). A total of 12 publications were included in this meta-analysis. The results of this meta-analysis suggested that miR-146a rs2910164 was associated with an increased risk of HCC (OR = 1.09, 95% CI = 1.00-1.19). In sensitivity analysis, the result was still positive when excluding the studies without HWE (OR = 1.12, 95% CI = 1.01-1.23). In conclusion, this meta-analysis suggested a significant association between miR-146a rs2910164 polymorphism and HCC risk.
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Background: To evaluate the efficacy and safety of apatinib in patients with metastatic colorectal cancer (mCRC) refractory to standard therapies.
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Apatinib (YN968D1) is a novel and highly selective tyrosine kinase inhibitor that inhibits vascular endothelial growth factor receptor-2 (VEGFR-2) and is approved as a third-line and subsequent-line treatment for advanced gastric adenocarcinoma or gastroesophageal junction adenocarcinoma in China.Apatinib is also widely studied in other solid tumors.With the increase in clinical research of apatinib, its adverse effects have also received widespread attention.Hence, this article summarizes the pharmacological properties of apatinib and reviews its clinical use in advanced or metastatic cancers.We highlight the common adverse reactions of apatinib in clinical applications and we also clarify the corresponding prevention and intervention measures.Overall, this review will help us better understand the safety and efficacy of apatinib treatment.
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Abstract Objective A meta-analysis was performed to compare the efficacy and safety of apatinib combined with chemotherapy in the second-line and subsequent lines of advanced gastric cancer. Methods A computerized systematic search of databases such as PubMed, Embase, the Cochrane Library, CNKI, Wanfang Data, and VIP e-Journals was performed to find literature comparing apatinib combined with chemotherapy in the treatment of advanced gastric cancer.Literature search, quality assessment and data extraction were performed independently by two researchers. Stata 16 software was used to process and analyze the data. And, we assessed heterogeneity with I2 and p-value, and performed sensitivity analysis. Results A total of 1217 patients with advanced gastric cancer were included in 13 studies, including 652 patients in the apatinib combined with chemotherapy group and 565 in the chemotherapy group.Meta-analysis results showed that the objective response rate (ORR) of the observation group was better than that of the control group(0R = 2.49, 95% CI = 1.86–3.34), and the disease control rate (DCR) of the observation group was also better than that of the control group(OR = 2.78,95% CI = 2.11–3.66).The R0 resection rate was also statistically significant(OR = 2.31, 95% CI = 1.09–4.92).In addition, when comparing total adverse reactions (AEs) at any level, there was a statistical difference(OR = 1.61, 95%CI = 1.39–1.86). Conclusion Compared with the chemotherapy group, apatinib combined with chemotherapy has better efficacy and controllable safety in advanced gastric cancer.
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Introduction: Antiangiogenesis therapy plays an important role in cancer treatment. Apatinib mesylate, a small molecule tyrosine kinase inhibitor targeting vascular endothelial growth factor receptor-2, has been recommended as third-line treatment for metastatic gastric cancer patients.Areas covered: The current review summarizes the publications and conference reports relating to apatinib from preclinical and clinical research in gastric cancer. Apatinib showed good safety, tolerance and treatment efficacy in Phase I/II studies. In a Phase III study, apatinib prolonged the median overall survival of patients with chemotherapy-refractory metastatic gastric cancer by 55 days and the median progression-free survival by 25 days compared with placebo.Expert opinion: Apatinib is a new treatment option for advanced gastric cancer. Apatinib is expected to have a broader application when it has been evaluated worldwide. The key issues are to find biomarkers and overcome drug resistance.
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This study aimed to compare the efficacy and safety of apatinib plus drug-eluting bead (DEB) transarterial chemoembolization (TACE), apatinib plus conventional TACE (cTACE) and apatinib alone in advanced intrahepatic cholangiocarcinoma (ICC) patients. We analyzed 35 advanced ICC patients retrospectively, including the apatinib plus DEB-TACE group (n=10), the apatinib plus cTACE group (n=12) and the apatinib group (n=13). Treatment response, survival data (including progression-free survival (PFS) and overall survival (OS)) and adverse events were assessed during the follow-up. Both the objective response rate (ORR) and the disease control rate (DCR) showed trends to be the highest in the apatinib plus DEB-TACE group (ORR: 84.6%/DCR: 100.0%), followed by the apatinib plus cTACE group (ORR: 75.0%/DCR: 91.7%) and then the apatinib group (ORR: 40.0%/DCR: 80.0%). PFS and OS were both the highest in the apatinib plus DEB-TACE group, followed by the apatinib plus cTACE group, and the shortest in the apatinib group, which was also confirmed by a multivariate Cox regression analysis. The incidences of adverse events were similar between the apatinib plus DEB-TACE group and the apatinib plus cTACE group but were higher in the apatinib plus DEB-TACE group and the apatinib plus cTACE than in the apatinib group; however, all of the adverse events were tolerable in the three groups. In conclusion, apatinib plus DEB-TACE is a promising therapeutic strategy for the treatment of advanced ICC.
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