The combination of apatinib and S-1 for the treatment of advanced gastric cancer in China: A meta-analysis of randomized controlled trials

BACKGROUND: Apatinib-targeted therapy is considered a promising treatment option for malignancies. This study systematically evaluated the efficacy and safety of the combination of apatinib and S-1 for the treatment of patients with advanced gastric cancer (GC). METHODS: Clinical trials were searched from the PubMed, Cochrane Library, Embase, CNKI, and Wanfang databases. Outcome measures including therapeutic efficacy, quality of life (QoL), and adverse events were extracted and evaluated. RESULTS: Data from 8 trials including 393 patients with advanced GC were included. The results indicated that, compared with S-1 alone, the combination of apatinib with S-1 significantly improved patient partial response rate (odds ratio [OR] = 1.91, 95% confidence interval [CI] = 1.21–3.02, P = .005), overall response rate (ORR, OR = 2.40, 95% CI = 1.51–3.82, P = .0002), and disease control rate (DCR, OR = 2.78, 95% CI = 1.51–5.10, P = .0010), whereas the rates of complete response (CR, OR = 2.38, 95% CI = 0.93–6.12, P = .07) and stable disease (SD, OR = 0.99, 95% CI = 0.64–1.54, P = .97) and QoL (OR = 1.22, 95% CI = 0.51–2.92, P = .66) did not differ significantly. Moreover, the group receiving the combined therapy had higher rates of hand-foot syndrome (OR = 2.23, 95% CI = 1.19–4.17, P = .01), hypertension (OR = 8.85, 95% CI = 4.07–19.26, P < .00001), albuminuria (OR = 11.25, 95% CI = 3.32–38.06, P = .0001), and hemoglobin reduction (OR = 3.19, 95% CI = 1.32–7.67, P = .010), whereas analysis of other adverse events did not show significant differences (P > .05). CONCLUSION: The combination of apatinib and S-1 is more effective for GC treatment than S-1 alone. However, this combined treatment could lead to increased hand-foot syndrome, hypertension, albuminuria, and hemoglobin reduction. Therefore, the benefits and risks should be considered before treatment.