Efficacy of apatinib as third-line treatment of advanced colorectal cancer and prognostic analysis

Purpose: To explore the efficacy and safety of apatinib mesylate in the third-line treatment of advanced colorectal cancer after the standard second-line treatment failed, and to analyze the possible factors affecting the prognosis. Methods: The clinical data of 52 patients with advanced colorectal cancer who failed or were intolerant of the standard second-line treatment performed in our hospital from January 2017 to December 2018 were collected. All the patients received the third-line treatment with apatinib mesylate tablets that were administered at 500 mg q.d. with 28 d as an administration cycle, and the clinical efficacy of apatinib mesylate and incidence of adverse reactions were recorded and analyzed. Besides, the survival and disease progression of the patients were followed up and recorded, and the influencing factors for the prognosis were analyzed. Results: The remaining 50 patients had efficacy evaluation, and it was found that the overall response rate (ORR) and disease control rate (DCR) were 8.0% (4/50) and 50% (25/50), respectively. The median survival, median progression-free survival (mPFS) and 1-year overall survival (OS) rate were 7.6 +/- 2.5, 4.0 +/- 1.7 and 26.9% (14/52), respectively. After treatment, the patients had increased scores for all items on the functional scale of the Quality of Life Questionnaire Core 30 (QLQ-C30). Decreases in the scores for all items on the symptomatic scale were also found after treatment, and the mitigation of the symptoms nausea and vomiting and pain was statistically significantly different. According to multivariate analysis results, the mPFS was significantly prolonged in the patients with CerB2(++/+++), the positivity rate of Ki-67 >= 50% and the presence of hypertension after treatment. Conclusions: Apatinib is effective in the third-line treatment of advanced colorectal cancer, significantly improves the patient quality of life, and causes tolerable adverse reactions. The mPFS is markedly extended in the patients with CerB2(++/+++), positivity rate of Ki-67 >= 50% and the presence of hypertension after treatment, which are the independent factors affecting the efficacy.