# The evaluation of the efficacy and safety about apatinib combined with immune checkpoint inhibitors in advanced gastric cancer: a real-world study

## TL;DR

This study finds that combining apatinib with immune checkpoint inhibitors improves survival in advanced gastric cancer patients, especially those with liver metastasis, without increasing severe side effects.

## Contribution

The study provides real-world evidence supporting the efficacy of apatinib combined with ICIs in advanced gastric cancer.

## Key findings

- Combination therapy improved median overall survival to 6.0 months compared to 3.0 months with apatinib alone.
- Patients with liver metastasis had significantly better survival with combination therapy.
- Safety profiles were comparable between the two treatment groups.

## Abstract

Apatinib and immune checkpoint inhibitors (ICIs) have shown promise as third-line treatments for advanced gastric cancer (AGC). This study compared the efficacy and safety of apatinib combined with ICIs versus apatinib monotherapy in AGC patients after second-line treatment failure.

We conducted a retrospective analysis of 48 AGC patients with postoperative recurrence/metastasis treated at Zhejiang Provincial People’s Hospital between January 2018 and September 2022. Patients received either apatinib plus ICIs (n=23) or apatinib alone (n=25). Primary endpoints were overall survival (OS) and progression-free survival (PFS); Secondary endpoints included safety and subgroup analyses.

With median follow-up of 4.25 months, the combination group showed significantly longer median OS (6.0 vs 3.0 months, HR=0.44, 95%CI 0.24-0.82, P=0.009) and PFS (3.0 vs 2.0 months, P=0.155). Subgroup analysis revealed patients with liver metastasis receiving combination therapy had superior OS (7.5 vs 4.0 months, P=0.036). The objective response rate was higher with combination therapy (4.3% vs 0%), though not statistically significant (P=0.292). Safety profiles were comparable between groups, with no significant increase in severe adverse events with combination therapy.

Apatinib combined with ICIs demonstrated improved survival outcomes compared to apatinib monotherapy in AGC, particularly for patients with liver metastasis, without increasing severe toxicity.