Abstract:Objective To explore the efficacy and safety of apatinib in the second-line treatment of advanced gastric cancer, providing a reference to guide treatment decisions for patients with advanced gastric cancer who are unable to endure chemotherapy. Methods A total of 45 patients with advanced gastric cancer, who underwent apatinib treatment after failure of first-line treatment at Jiangsu Cancer Hospital from August 2017 to June 2022, were selected as the subjects for this study. All patients underwent second-line therapy due to failure of first-line therapy. The second-line treatment regimens included four types of combination regimens: apatinib combined with immunotherapy, chemotherapy, immunotherapy plus chemotherapy, antibody-drug conjugate plus chemotherapy, respectively, and patinib monotherapy meanwhile. Survival analysis was performed using the Kaplan-Meier method and log-rank test, while factors influencing median progression-free survival (PFS) were analyzed using the Cox regression model. Stratification factors included gender, age, taking operation or not, microsatellite instability (MMR) status, human epidermal growth factor receptor 2 (HER-2) expression, and programmed cell death receptor 1 (PD-1) / ligand 1 (PD-L1) expression. Results Follow-up untill 2023-12-31, among the 45 patients, the disease control rate (DCR) of apatinib was 48.9%, with a median PFS of 5.0 months. The combination of apatinib with immunotherapy and chemotherapy produced the optimal outcomes, with a median PFS reaching 7.6 months. There was no statistically significant difference in PFS among the various treatment regimens (P＞0.05). Furthermore, the PFS differences among various groups stratified by gender, age, taking operation or not, HER-2 expression, PD-1/PD-L1 expression, and MMR status were also not statistically significant (P＞0.05). The most common adverse reactions were gastrointestinal disturbances (8.9%) and leukopenia (8.9%), but all adverse reactions were manageable. Conclusion Apatinib has some advantages in the second-line treatment of advanced gastric cancer, especially the combination regimen of immunotherapy, chemotherapy and apatinib may bring survival advantages to patients.