paclitaxel + apatinib + S-1

The combination of paclitaxel, apatinib, and S-1 is a multi-drug regimen primarily used for treating advanced gastric cancer, particularly in conversion therapy settings. This combination leverages the anti-angiogenic properties of apatinib alongside the cytotoxic effects of paclitaxel and S-1. ## Composition and Mechanism This regimen combines three distinct agents: 1. **Paclitaxel** - A taxane-based chemotherapy agent that works by stabilizing microtubules, preventing cell division, and exhibiting inherent anti-angiogenic properties through direct mediation of endothelial cell function and inhibition of VEGF-induced angiogenesis[4]. 2. **Apatinib** - A novel, small molecule anti-angiogenesis inhibitor that specifically targets vascular endothelial growth factor receptor-2 (VEGFR-2) and regulates its mediated signaling pathway[5]. 3. **S-1** - An oral fluoropyrimidine derivative that combines tegafur (a prodrug of 5-fluorouracil), gimeracil, and oteracil potassium[1]. ## Clinical Applications The combination has shown promising results in several clinical contexts: - **Conversion Therapy for Unresectable Gastric Cancer**: Multiple studies have demonstrated that this regimen can achieve high objective response rates (ORR) of 71.2-73.3% and disease control rates (DCR) of up to 93.3%[1][4]. - **R0 Resection Rates**: In patients with initially unresectable gastric cancer, the combination therapy enabled R0 resection (complete removal of all visible tumor with negative margins) in 70.8% of surgical cases in one study[1]. - **Survival Benefits**: Patients who underwent successful conversion therapy followed by surgery showed significantly improved one-year overall survival rates (93.8%) compared to those who could not undergo surgery (61.1%)[1]. ## Dosing Regimen The typical administration schedule includes: - **Apatinib**: 500-850 mg orally daily for 21 consecutive days[1][2][5] - **Paclitaxel**: 130 mg/m² intravenously on day 1 (or 130 mg/m² on days 1 and 8 in some protocols)[1][4][7] - **S-1**: 80 mg/m² orally twice daily for 14 consecutive days of a 21-day cycle[1][5] For patients with peritoneal metastasis, a modified paclitaxel regimen may be used: 90 mg/m² intravenously plus 40 mg/m² intraperitoneally on day 1[5]. ## Safety Profile Common adverse events include: - Hematological toxicities: neutropenia, leukopenia, and anemia - Hypertension - Gastrointestinal effects In one study, 85% of patients experienced apatinib treatment-emergent adverse events, and 90% experienced chemotherapy-related adverse events[2]. This combination represents an important therapeutic approach for patients with advanced gastric cancer, particularly those who may benefit from conversion to surgical resectability.

Other names

IP/IV paclitaxel plus apatinib and S-1Paclitaxel, Apatinib, and S-1 in Gastric Cancer Conversion Therapy