Treatment Of Gastric Cancer Patients Research Articles

Capecitabine plus oxaliplatin versus capecitabine plus oxaliplatin with concurrent radiotherapy in the treatment of gastric cancer after D2 gastrectomy.

4059Background: The role of adjuvant chemoradiotherapy (CRT) in the treatment of gastric cancer patients after D2 resection has not been defined yet. This trial was designed to compare capecitabine...

ANALYTICAL EPIDEMIOLOGY OF GASTRIC CANCER IN THE REPUBLIC OF CRIMEA AND ITS CONFORMITY WITH ALL-RUSSIAN TRENDS

Gastric cancer (GC) is one of the most common malignant tumor, both world-wide and in the Russian Federation (RF), possessing one of the highest mortality rates. The aim of current research was to analyze the main epidemiological data, the rates reflecting the diagnostics and results of treatment of GC patients in the Republic of Crimea (RC) and to compare with national trends. Using the extensive, intensive, standardized rates, estimated by world standard method, structural analysis of the epidemiology of GC in RC for the period from 2007 to 2016 was carried out. The obtained results made it possible to compare these data with the main GC rates in RF. Results of the study. The incidence of GC in RC decreased during 10 years, for men - 16,42 (4th place), for women - 6,68 (9th place) per 100 000 of the population. By 2021 a further decline in morbidity in men is expected to be 30,27% and a possible increase in the female incidence rate - by 17,54%. The average age of GC patients in RC was 66,5 years. Index accuracy was 0,75, which testified to satisfactory conditions of specialized treatment for this tumor. Mortality from GC at the 1st year of life in RC was higher than in RF - 56,0%, which was due to low active diagnostics - 3,6% and accordingly a high proportion of GC patients of IV stage - 43,3%. Ratio index in RC for 10 years was higher than in RF and increased from 3,5 to 4,4; prevalence rate of GC in RC was lower - 84,1 per 100 000 of the population in comparison with RF, GC mortality index - 15,3 per 100 000 of the population that was lower than in RF. The proportion of patients who have been observed for 5 years or more in RC was 57,3% that was more than in RF. Conclusions. The rates reflecting early diagnostics of GC in RC are worse than all-Russian ones, which makes it necessary to develop medical examination program for the population of RC for this malignancy. The growth of ratio index, the lower mortality rates and the greater proportion of people who have been observed for 5 years or more indicates the best results of treatment of patients with GC in RC compared with similar data in RF.

Updated results of MSCMCC gastric cancer cohort: Indirect comparison between adjuvant chemoradiation and perioperative chemotherapy in gastric cancer patients.

123 Background: In the western world gastric cancer patients are either treated with peri-operative chemotherapy or adjuvant chemoradiation and no direct comparisons of these two treatment strategies are available. In our referral gastric cancer center (MSCMCC) we have changed in January 2013 the treatment protocol from adjuvant chemoradiation (like in INT-0116 study) to peri-operative chemotherapy (ECF or CF regimen). Here we report the updated results of single institution indirect comparison of two treatment strategies in the treatment of gastric cancer patients. Methods: 139 consecutive pts who underwent gastrectomy between 2009-2015 treated at MSCMCC were identified in a cohort manner (2009-2012 radiochemotherapy: 60 pts; 2013-2015- peri-operative chemotherapy: 79 pts). The patients’ clinical characteristics were collected from medical records. All patients were followed for relapse and survival with median observation time of 57 and 17 months for chemoradiation and peri-operative chemotherapy respectively. Results: The patients’ characteristics were similar in two groups including, age, sex, ECOG status and Lauren-classification types. DFS was similar in both arms with 47% of patients in radiochemotherapy and 63% of peri-operative chemotherapy patients without relapse at 2 years cut-off (p=0.17). OS was not significantly different between the groups (p=0.783). The toxicity profile was similar in two cohorts, with only leukopenia reported more often in the chemoradiation group (grade 3-4: 43.3% vs 12.3%. p<0.001) and low platelet count (grade 3-4: 6.7% vs 3.7%; p=0.19).There was a trend for excessive mucositis (p=0.067) and diarrhea (p=0.051) in the chemoradiation group. Vomiting more often observed in the peri-operative chemotherapy group (grade 3-4: 29.6% vs 13.3%, p=0.032). Notable, no differences were reported for neutropenia, fatigue and weigth loss. Conclusions: This indirect comparison suggests that results of two modalities are similar in terms of RFS. Further follow up is needed to assess the impact on survival. The toxicity profile favours the peri-operative chemotherapy.

NOB1 Gene as a Potential Biomarker in Clinical Outcomes and Prognosis of Patients with Gastric Cancer.

To investigate relationship of the Nin one binding protein (NOB1) gene with the prognosis of gastric cancer (GC). The GC tumor tissues and paired adjacent normal gastric tissues were collected from 65 patients who underwent primary gastric resection surgery in our hospital from January 2009 to July 2011. Data including age, gender, family cancer history, tumor diameter, pathological type, differentiation, clinical stage by tumor node metastasis (TNM) staging, lymphatic metastasis, and distant metastasis were collected. Expression of NOB1 and VEGF was determined using real time PCR. The relationship of NOB1 with clinical outcomes and prognosis of GC patients was analyzed by statistical methods. Both mRNA expression of NOB1 and VEGF was significantly higher in tumor tissues than that of the normal tissues, p < 0.05, and mRNA expression of NOB1 was positively correlated with mRNA expression of VEGF by Pearson's correlation analysis. Significant difference was observed in TNM stage, tumor differentiation, and metastasis between the low and high NOB1 expression groups, p < 0.05, while no significant difference was observed in age, gender, family cancer history, tumor location, and diameter. Univariate analysis showed that TNM stage, tumor differentiation, lymphatic metastasis, distant metastasis and expression of NOB1 and VEGF were all significantly different in survival and dead patients. Logistic analysis showed that NOB1 was an independent risk factor for 5-year mortality of GC patients, as well as lymphatic metastasis and distant metastasis. NOB1 was correlated with clinical outcomes and prognosis of GC patients and was an independent risk factor for 5-year mortality of GC patients. This study might provide more clinical evidences for NOB1 in GC and give a new target for diagnosis and treatment for GC patients.

A systematic review and meta-analysis of robot-assisted versus laparoscopically assisted gastrectomy for gastric cancer.

Robotic-assisted gastrectomy (RAG) has been used for gastric cancer since 2002. This meta-analysis was carried out to evaluate whether RAG is safer and more effective than conventional laparoscopically assisted gastrectomy (LAG) for gastric cancer. We performed a manual search for these 2 types of operations (RAG and LAG) in the PubMed, Embase, and the Cochrane Library databases up to April 30, 2016. Twelve nonrandomized controlled trials that reported on RAG and LAG for gastric cancer were included. Outcomes evaluated included operation time, number of retrieved lymph nodes, blood loss, length of the resection margin, complications, and postoperative hospital stay. A total of 3744 patients in 12 studies were included (1134 patients in the RAG group and 2610 patients in the LAG group). The operation time was significantly shorter in the LAG group [weighted mean difference (WMD) 42.0 (95% confidence interval, 95% CI 28.11-55.89) minutes; P < .00001], while the loss of blood volume was lower in the RAG group (P = .01). The number of retrieved lymph nodes, duration of postoperative stay, length of the proximal resection margin, length of the distal resection margin, and postoperative complications were similar between groups. We conclude that RAG is a safe and appropriate treatment for gastric cancer patients in comparison to LAG. Nevertheless, RAG is not superior to LAG. Future research on RAG should focus on comparing the differences in retrieved lymph nodes in different tiers, evaluating the postoperative recovery and reducing the cost of the treatment.

Gastric cancer diagnosis after presentation to the ED: The independent association of presenting location and outcomes

BackgroundThe impact of diagnosis location on gastric cancer (GC) outcomes is poorly defined. MethodsDetailed chart review was conducted to identify presenting location leading to diagnosis and treatment for GC patients at a single institution (2009–2013). Patients treated non-emergently following a diagnosis prompted by an ED visit (EDdx) were compared with those diagnosed at other locations (non-EDdx). ResultsEDdx patients comprised 52% of 263 GC patients. They were older, had later cancer stages (stage IV: 50% vs. 24%), more comorbidities (≥3: 68% vs. 47%), and presented with non-specific symptoms like bleeding (21% vs. 5%). Both groups were of similar race and insurance status. In a model adjusted for stage, EDdx was associated with increased mortality (aHR 1.9; 95% CI: 1.2–2.9). ConclusionHalf of GC patients had an ED visit prompting diagnosis, which is independently associated with increased mortality. Efforts should focus on reducing EDdx rates to improve GC outcomes.

Traditional Chinese medicine integrated with chemotherapy for stage IV non-surgical gastric cancer: a retrospective clinical analysis

ObjectiveTraditional Chinese medicine (TCM) is regarded as an important treatment for gastric cancer patients, especially for those in advanced stage. To evaluate the effects of TCM treatment on gastric cancer patients, the authors performed a retrospective study to report the result of the integrated treatment of TCM with chemotherapy for stage IV non-surgical gastric cancer. MethodsIn this study, 182 patients with stage IV and non-surgical gastric cancer were retrospectively analyzed to evaluate the effects of TCM integrated with chemotherapy. Among the 182 cases, 88 cases received integrated therapy consisting of TCM and chemotherapy, while 94 cases received chemotherapy alone. The overall survival and Karnofsky performance status (KPS) score were measured as the main outcome. ResultsThe median overall survival of the integrated therapy group and chemotherapy group were 16.9 and 10.5 months, respectively. The 1-, 3- and 5-year survival rates of integrated therapy group vs. chemotherapy group were 70% vs. 32%, 18% vs. 4%, and 11% vs. 0%, respectively. There was a significant difference between the two groups (χ2 = 42.244, P < 0.001). After six-month treatment, KPS scores of the integrated therapy group and the chemotherapy group were 75.00 ± 14.78 and 60.64 ± 21.39, respectively (P < 0.001). The Cox regression analysis showed that TCM treatment is a protective factor for patients' overall survival. ConclusionThis study demonstrated that TCM integrated with chemotherapy may prolong overall survival and improve survival rate and life quality of patients with stage IV non-surgical gastric cancer.

Baseline characteristics, survival and direct costs associated to treatment of gastric cancer patients at the National Oncology Institute of Panama from 2012 to 2015: a hospital-based observational study

ObjectivesComprehensive epidemiological and economic studies of gastric cancer (GC) in Panama are limited. This study aims to evaluate the association between socioeconomic and clinical variables with survival, describe the survival...

Evaluation of hepatectomy and palliative local treatments for gastric cancer patients with liver metastases: a propensity score matching analysis.

BackgroundThe optimal treatments for gastric cancer with liver metastases (GCLM) remain controversial. This study aimed to evaluate the efficacy of hepatectomy, RFA and TACE as local treatments for GCLM.MethodsFrom 2001 to 2015, 119 consecutive patients who received multidisciplinary treatments based on curative gastrectomy and local treatments (hepatectomy, RFA and TACE) for liver metastases were enrolled in this retrospective cohort study. Patients were divided into Group A (46, hepatectomy) and Group B (73, either or both RFA and TACE). Propensity score matching analysis was employed.ResultsThe propensity model revealed that hepatectomy was associated with significantly longer OS compared with either or both RFA and TACE (P=0.021). The 1-, 3- and 5-year OS rates were 80.5%, 41.5% and 24.4%, respectively in Group A; and 85.4%, 21.9% and 12.2%, respectively in Group B. Subgroup analyses indicated that hepatectomy was associated with significantly longer long-term survival compared with TACE (P=0.033) and RFA (P=0.010). TACE had a similar efficacy as RFA (P=0.518), but with significantly lower costs (P=0.014) in for patients with metachronous GCLM.ConclusionHepatectomy is the optimal local treatment for GCLM when surgical R0 resection is intended. TACE attained a similar prognosis as RFA with relatively high cost-effectiveness, particularly for patients with metachronous GCLM.

Consideration of clinicopathologic features improves patient stratification for multimodal treatment of gastric cancer.

Preoperative staging of gastric cancer with computed tomography alone exhibits poor diagnostic accuracy, which may lead to improper treatment decisions. We developed novel patient stratification criteria to select appropriate treatments for gastric cancer patients based on preoperative staging and clinicopathologic features. A total of 5352 consecutive patients who underwent gastrectomy for gastric cancer were evaluated. Preoperative stages were determined according to depth of invasion and nodal involvement on computed tomography. Logistic regression analysis was used to identify clinicopathological factors associated with the likelihood of proper patient stratification. The diagnostic accuracies of computed tomography scans for depth of invasion and nodal involvement were 67.1% and 74.1%, respectively. Among clinicopathologic factors, differentiated tumor histology, tumors smaller than 5 cm, and gross appearance of early gastric cancer on endoscopy were shown to be related to a more advanced stage of disease on preoperative computed tomography imaging than actual pathological stage. Additional consideration of undifferentiated histology, tumors larger than 5 cm, and grossly advanced gastric cancer on endoscopy increased the probability of selecting appropriate treatment from 75.5% to 94.4%. The addition of histology, tumor size, and endoscopic findings to preoperative staging improves patient stratification for more appropriate treatment of gastric cancer.

Application practice of comfortable medical concept in patients with gastric cancer surgery

Objective To explore the application effect of comfortable medical concept in patients with gastric cancer surgery. Methods A total of 238 patients who underwent radical resections for gastric cancer in Department of Gastrointestinal Surgery were chosen from January 2015 to November 2015. These patients were divided into observation group (120 cases) and control group (118 cases) according to development time of comfortable medical concept. Comfortable medical concept was applied in the observation group and routine medical concept for control group. Preoperative anxiety score, postoperative pain score, postoperative length of intestinal function recovery time, leaving bed and hospital stay, hospitalization expense, postoperative complication and satisfaction degree were observed as the main indexes to discriminate the two groups. Results Patients in observation group were demonstrated having lower postoperative anxiety score and pain score, shorter length of postoperative intestinal function recovery time and hospital stay, faster time of leaving bed, lower hospitalization expense, higher satisfaction degree compared with that of control group (P 0.05) . Conclusions It is safe and effective to apply the comfortable medical concept to perioperative treatments for gastric cancer patients, which can significantly improve the patient's comfortable experience and accelerate the postoperative rehabilitation. Key words: Gastric cancer; Perioperative period; Comfortable medical concept

Phosphorylation by mTORC1 stablizes Skp2 and regulates its oncogenic function in gastric cancer

BackgroundBoth mTOR and Skp2 play critical roles in gastric cancer (GC) tumorigenesis. However, potential mechanisms for the association between these two proteins remains unidentified.MethodsThe regulatory role for mTORC1 in Skp2 stability was tested using ubiquitination assay. The functions of p-Skp2 (phosphorylation of Skp2) were studied in vitro and in vivo. Expression of p-Skp2 and p-mTOR (phosphorylation of mTOR) were shown in GC lines and in 169 human primary GC tissues.ResultsmTORC1 can directly interact with Skp2 and phosphorylated Skp2 at Ser64, which sequentially protect Skp2 from ubiquitination and degradation. Furthermore, the phospho-deficient p-Skp2 (S64) mutant significantly suppresses GC cell proliferation and tumorigenesis. The expression of p-Skp2 was associated with p-mTOR in GC cell lines and tissues. Interestingly, the combination of p-Skp2 and p-mTOR was a better predictor of survival than either factor alone.ConclusionThe mTORC1 function to regulate Skp2 by Ser64 phosphorylation may represent an oncogenic event in GC tumorigenesis. Moreover, our study also indicates that Skp2 Ser64 expression is a potential indicator in the treatment of GC patients using mTORC1 inhibitor.

Cost minimization analysis of capecitabine versus 5-fluorouracil-based treatment for gastric cancer patients in Hong Kong

Background: EOX (epirubicin, oxaliplatin, Xeloda; capecitabine) and FOLFOX4 (5-fluorouracil (5-FU), leucovorin, oxaliplatin) are the common chemotherapy regimens used in the treatment of advanced gastric cancer (aGC) in Hong Kong. This study aimed to compare the costs of these therapies for aGC patients from both the healthcare and societal perspectives. It should be noted that, while FOLFOX4 is routinely administered in an outpatient setting in North America and Europe, inpatient setting is adopted in Hong Kong instead, incurring hospitalization cost as a result.Methods: Fifty-eight patients were identified from the electronic records in two public tertiary hospitals, with 45 and 13 receiving EOX and FOLFOX4 regimens, respectively. Healthcare cost was direct medical costs including drugs, clinic follow-up, hospitalization, diagnostic laboratories, and radiographs. Societal cost refers to indirect costs such as patient time and travel costs. Cost items were further classified as “expected” or “unexpected”. All cost data was expressed in US dollars.Results: Patients in the EOX and FOLFOX4 arm received an average of 5.3 and 7.8 cycles of treatment, respectively. The capecitabine-based regimen group had a higher expected medication cost per cycle when compared to the 5-FU-based treatment group (US$290.3 vs US$66.9, p < .001), but lower expected hospitalization costs (US$76.9 vs US$1,269.2, p < .001). The total healthcare cost and total societal cost per patient was reduced by 67.2% (US$5,691.9 vs US$17,357.4, p < .001) and 25.3% (US$3,090.5 vs US$4,135.1, p = .001), respectively, in the capecitabine-based regimen group. Sensitivity analyses based on full cycle regimen costs and net capecitabine or 5-FU/leucovorin costs still showed EOX to be less costly than FOLFOX4.Conclusion: The capecitabine-based regimen, EOX, was found to generate significant cost saving from both the healthcare and societal perspectives in regions in which FOLFOX4 is given in an inpatient setting.

Clinical significance of circulating tumor cells in gastric cancer patients.

Circulating tumor cells (CTCs) are rare cancer cells released from tumors into the blood stream that are thought to have a key role in cancer metastasis. Investigation of CTCs is an exciting area of research but remains in its infancy, and the presence of CTCs has been associated with worse prognosis in several major cancer types. Gastric cancer (GC) is a highly lethal malignancy and a serious public health concern in East Asia especially in China. There is an urgent need for identifying new, better prognostic markers to enhance diagnosis and prognosis, facilitate drug development, and to improve the treatment of gastric cancer patients. There are considerable interests in gastric CTCs given their potential use as gastric cancer biomarkers. This review highlights recent advances in studies of gastric CTCs, including the isolation and biological molecular characteristics of gastric CTCs, and their clinical significance.

Overexpression of ANXA3 is an independent prognostic indicator in gastric cancer and its depletion suppresses cell proliferation and tumor growth.

BackgroundGastric cancer (GC) is one of the most common malignancies worldwide. Tumour metastasis is one of the leading causes of death in GC patients. This study aims to investigate the significance of ANXA3 expression and the mechanism by which ANXA3 is involved in the epithelial–mensenchymal transition (EMT) of gastric cancer cells.ResultsOur results confirmed that ANXA3 was high expression at the mRNA and protein level in GC cancer tissues and the majority of GC cell lines. In clinicopathological analysis, we found that increased expression of ANXA3 in tumors was closely associated with a poor prognosis. Xogenous ANXA3 transduction promoted proliferation, clone formation, migration, and invasion. Small interfering RNA silencing of ANXA3 inhibited these processes. Silence of ANXA3 inhibited tumorigenicity in vivo. Additionally, ANXA3 expression is associated with the epithelial–mesenchymal transition.MethodsFirstly, we investigated the ANXA3 expression on mRNA and protein level with RT-PCR and Western blot. Secondly, 183 GC patients tissues were used the to evaluate the clinicopathological characteristics and prognosis through immunohistochemistry. Furthermore, The functions of ANXA3 were analyzed in the cell proliferation, Colony Formation, migration, invasion and apoptosis of GC cell lines.ConclusionsOur research suggests that ANXA3 plays important roles in gastric cancer carcinogenesis and metastasis, and provides a valuable prognostic marker and potential target for treatment of gastric cancer patients.

B38 - Adjuvant treatment in gastric cancer patients with radiochemotherapy

B38 - Adjuvant treatment in gastric cancer patients with radiochemotherapy

Isoproterenol regulates CD44 expression in gastric cancer cells through STAT3/MicroRNA373 cascade.

Gastric cancer is a heterogeneous disease, and stem cells are thought to be the cell of origin contributed to this malignancy. However, studies with breast and intestinal cancer models show non-stem cancer cells can change their surface phenotype and convert into tumor-initiating cells induced by the signals emanating from surrounding tumor microenvironment. Here, we show that CD44 was expressed at different levels in gastric metastases compared with primary tumors, and also negatively correlated with the expression of miR-373. By using a panel of human gastric cancer cell lines and analysis of archived data from The Cancer Genomics Altas (TCGA) database, we verified the inverse correlation between CD44 and miR-373. Furthermore, the stress-associated hormone, isoproterenol, could increase the expression levels of "stem"-related proteins, such as CD44, Nanog, and Rex-1, and induce chemoresistance in gastric cancer cells. Transfection with miR-373, however, reversed not only the effect of isoproterenol on phenotypic conversion but also its effect on drug sensitivity. Isoproterenol triggered downstream target STAT3 mainly through β2-adrenergic receptors (β2-ARs). Activated STAT3 functioned as a miR-373 suppressor by binding to its promoter, which forms a positive feedback circuit to maintain CD44 activity and direct the phenotypic conversion from CD44(low) to CD44(hi) expression. Our data suggest an important role of β2-AR/STAT3/miR-373 signaling on the transformation of gastric cancer cells. This study also suggests a potential therapeutic or preventive treatment for gastric cancer patients who are especially prone to psychosocial stress.

Abstract 1808: Nuclear receptor, ESRRG functions as tumor suppressor by preventing Helicobacter pylori infection in gastric cancer

Abstract Gastric cancer (GC) is the most common cancer type in Asia. Surgical resection and chemotherapy is standard treatment of GC. Molecular therapeutic targets and mechanism contributing to develop the gastric cancer is poorly understood. To discover the molecular target in gastric cancer, we analyzed gene expression data from gastric cancer patients. Data analysis reveals that nuclear receptor ESRRG is top candidate gene conferring the tumor suppressive property in gastric cancer. ESRRG expression is down-modulated by Helicobacter pylori (H. pylori) infection, which is one of causing factor triggering gastric cancer. In addition, ectopically over-expressed ESRRG protects the cell from H. pylori infection and suppressed cancer cell growth in vitro and in vivo mouse model. Gene expression profile reveals that TFF1, which is well known as tumor suppressor in gastric cancer is down-stream target of ESRRG and ESRRG well reflects clinical outcome in gastric cancer. Our study provides new molecular insights how ESRRG regulates gastric cancer cell growth induced by H. pylori and suggests possibility that ESSRRG can be therapeutic target for the treatment of gastric cancer patients. Citation Format: Myoung-Hee Kang, Yong-Soo Lee, Jin-Hak Jung, Young Soo Park, Jin-Yong Jeong, Mi-Na Kweon, Chan-Ki Paik, Seung-Jae Myung, Yun-Yong Park. Nuclear receptor, ESRRG functions as tumor suppressor by preventing Helicobacter pylori infection in gastric cancer. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 1808.

Nobiletin Induces Protective Autophagy Accompanied by ER-Stress Mediated Apoptosis in Human Gastric Cancer SNU-16 Cells.

Nobiletin, a major component of citrus fruits, is a polymethoxyflavone derivative that exhibits anticancer activity against several forms of cancer, including SNU-16 human gastric cancer cells. To explore the nobiletin-induced cell death mechanism, we examined the changes in protein expression caused by nobiletin in human gastric cancer SNU-16 cells by means of two-dimensional gel electrophoresis (2-DGE), followed by peptide mass fingerprinting (PMF) analysis. Seventeen of 20 selected protein spots were successfully identified, including nine upregulated and eight downregulated proteins. In nobiletin-treated SNU-16 cells the glucose-regulated protein 78 kDa (GRP78) mRNA level was induced most significantly among six proteins related to cell survival and death. Western blot analysis was used to confirm the expression of GRP78 protein. We detected increases in the levels of the ER-stress related proteins inositol requiring enzyme 1 alpha (IRE1-α), activating transcription factor 4 (ATF-4), and C/EBP homology protein (CHOP), as well as GRP78, in response to nobiletin in SNU-16 cells. Furthermore, the ER stress-mediated apoptotic protein caspase-4 was proteolytically activated by nobiletin. Pretreatment with chloroquine, an autophagy inhibitor, strongly augmented apoptosis in SNU-16 cells, as evidenced by decreased cell viability, an increased number of sub-G1 phase cells and increased levels of cleaved PARP. Our results suggest that nobiletin-induced apoptosis in SNU-16 cells is mediated by pathways involving intracellular ER stress-mediated protective autophagy. Thus, the combination of nobiletin and an autophagy inhibitor could be a promising treatment for gastric cancer patients.

Prevention of the adverse reaction application of bevacizumab in combination with chemotherapy in postoperative patients with gastric cancer

Objective To investigate the adverse reaction of gastric cancer patients after inquiry application of bevacizumab combined with chemotherapy, and put forward some corresponding preventive measures. Methods Sixty-five cases patients with gastric cancer who were treated with advanced gastric cancer radical operation application of bevacizumab in combination with chemotherapy in the Central Hospital of Jiangmen from January 2012 to January 2014, including 41 male, 24 female, with the average age of 48.7 years old.The adverse reactions were observed, and give the corresponding prevention and control measures on the basis of the adverse reaction conditions, the experience in the prevention and treatment were summarized according to the therapeutic effect with clinical and related literature. Results The adverse reactions caused by bevacizumab combined with chemotherapy in patients with gastric cancer including proteinuria(a total of 24 cases(37%), including 18 cases(27.8%) of (+ ), 6 cases(9.2%) of (+ + )), gastrointestinal reaction(a total of 10 cases(15.4%), including 8 cases(12.3%) of grade Ⅰ, 2 cases(3.1%) of grade Ⅱ), thrombosis(a total of 20 cases(30.7%), including 13 cases of grade Ⅰ(20%), 7 cases(10.7%) of grade Ⅱ) and hypertension(a total of 11 cases(16.9%), including 9 cases(13.8%) of grade Ⅰ, 2 cases(3.1%) of grade Ⅱ). Bevacizumab combined with chemotherapy in the treatment of gastric cancer patients with partial remission in 41 cases(63.1%), 10 cases(15.4%) of stable disease progression, 14 cases(21.5%) of disease progression, the complete remission rate was 63.1%.For adverse reactions of proteinuria, patients with asymptomatic proteinuria, if patients with urinary protein detection results for (+ ), without special treatment, when patients with urinary protein detection for (+ + ), given the observation, if patients with urinary protein was more than or equal to 2 g/24 h, paused bevacizumab until proteinuria<2 g. When the patients with digestive system damage, such as ALT and AST elevation, given the treatment of liver until the two hepatic enzymes returned to normal; patients with gastrointestinal reactions were nausea and vomiting, asked patient to light diet and regular esophagoscopy, if the patients appeared visceral fistula immediately stopped bevacizumab.For patients with thrombosis, should be closely monitored in patients with signs, once found regardless of any level of embolism events, all immediately stopped the chemotherapy drugs.For the main adverse reactions of hypertension, given patients with proper medication explain before the treatment to reduce the fear, tension, and avoiding mood disorders which lead to an increase in blood pressure, blood pressure should be regularly detected in patients who use drugs, if patients occurred a sharp rise in blood pressure during the treatment, immediately stopped bevacizumab and given antihypertensive treatment. Conclusion Clinicians should take the possible corresponding prediction in patients underwent application of bevacizumab in combination with chemotherapy on the possible different adverse reactions according to the actual situation of patients, and take corresponding preventive measures, can to some extent avoid serious adverse reaction occurred, and improve the quality of life of the patients. Key words: Gastric cancer; Chemotherapy; Adverse reaction; Bevacizumab