Neoadjuvant PD-1 Inhibitor Plus Apatinib and Chemotherapy Versus Apatinib Plus Chemotherapy in Treating Patients With Locally Advanced Gastric Cancer: A Prospective, Cohort Study

Abstract

Purpose This study aimed to evaluate the efficacy and safety of neoadjuvant programmed cell death-1 (PD-1) inhibitors plus apatinib and chemotherapy (PAC) in patients with locally advanced gastric cancer (LAGC). Materials and Methods Seventy-three patients with resectable LAGC were enrolled and named the PAC group (n=39) or apatinib plus chemotherapy (AC) group (n=34) based on the treatment they chose. Neoadjuvant therapy was administered in a 21-day cycle for 3 consecutive cycles, after which surgery was performed. Results The PAC group exhibited a higher objective response rate than the AC group (74.4% vs. 58.8%, P=0.159). Moreover, the PAC group showed a numerically better response profile than the AC group (P=0.081). Strikingly, progression-free survival (PFS) (P=0.019) and overall survival (OS) (P=0.049) were prolonged, whereas disease-free survival (DFS) tended to be longer in the PAC group than in the AC group (P=0.056). Briefly, the 3-year PFS, DFS, and OS rates were 76.1%, 76.1%, and 86.7% in the PAC group and 46.9%, 49.9%, and 70.3% in the AC group, respectively. Furthermore, PAC (vs. AC) treatment (hazard ratio=0.286, P=0.034) was independently associated with prolonged PFS in multivariate Cox regression analyses. The incidence of adverse events did not differ between the two groups (all P>0.05), where leukopenia, anemia, hypertension, and other adverse events were commonly observed in the PAC group. Conclusions Neoadjuvant PAC therapy may achieve a preferable pathological response, delayed progression, and prolonged survival compared to AC therapy with a similar safety profile in patients with LAGC; however, further validation is warranted.

WITHDRAWN: New Breakthrough in Triple-Negative Breast Cancer Treatment: A Study on the Clinical Efficacy and Safety of the Combination of Carrilizumab and Apatinib in Dual-Targeted Neoadjuvant Therapy

“…PD-1/PD-L1 inhibitors initially showed promising results in salvage therapy for advanced TNBC [9][10][11][12][13][14] . According to the IMpassion130 study, the combination of atezolizumab and albumin-bound paclitaxel successfully extended the overall survival of patients with advanced TNBC to up to 2 years [15] .…”

Evaluation of neoadjuvant immunotherapy in resectable gastric/gastroesophageal junction tumors: a meta-analysis and systematic review

“…Among the 33 included studies, there were seven randomized controlled trials (RCTs) ( 31 , 35 , 39 , 40 , 54 , 56 , 58 ) and 26 single-arm open-label cohort studies ( 27 , 28 , 30 , 32 – 34 , 36 – 38 , 41 – 53 , 55 , 57 , 59 , 60 ). The main neoadjuvant immunotherapy drugs used were avelumab, camrelizumab, pembrolizumab, sintilimab, tislelizumab, nivolumab, LP002, and durvalumab.…”