A single arm study: Apatinib plus paclitaxel as the reverses treatment in advanced gastric cancer which paclitaxel-resistant.

This trial investigated the efficacy and safety of apatinib plus paclitaxel, as a treatment option for patients with advanced gastric cancer which paclitaxel-resistant.

Inclusion Criteria:

1. Age: more than 18 years old;

2. Histologically confirmed advanced or metastatic adenocarcinoma of gastric cancer(AGC) , including adenocarcinoma of the gastroesophageal junction;

3. At least one measurable and evaluable disease based on response evaluation criteria in solid tumors (RECIST v1.1);

4. The patient with Prior Paclitaxel-Resistant;

5. Eastern Cooperative Oncology Group Performance Status (ECOG PS) of 0-2;

6. An expected survival of ≥ 3 months;

7. Duration from the last therapy is more than 6 weeks for nitroso or mitomycin, More than 4 weeks for other cytotoxic agents, operation or radiotherapy;

8. Major organ function has to meet the following criteria; (1) For results of blood routine test:

   1. Hemoglobin (HB) ≥ 80g / L,
   2. ANC ≥ 1.5 × 109 / L,
   3. PLT ≥ 75 × 109 / L, (2) For results of biochemical tests:
   1. BLT ≤ 1.25 times the upper limit of normal (ULN),
   2. ALT and AST ≤ 2.5 × ULN, liver metastases, if any, the ALT and AST≤ 5 × ULN,
   3. Serum Cr≤1ULN, Endogenous creatinine clearance rate >50ml/min;

9. Pregnancy test (serum or urine) has to be performed for woman of childbearing age within 7 days before enrolment and the test result must be negative. They shall take appropriate methods for contraception during the study until the 8th week post the last administration of study drug. For men, (previous surgical sterilization accepted), shall agree to take appropriate methods of contraception during the study until the 8th week post the last administration of study drug;

10. Patient has to voluntarily join the study and sign the Informed Consent Form for the study.

Exclusion Criteria:

1. History of other malignancies except cured basal cell carcinoma of skin and carcinoma insitu of uterine cervix;
2. Confirmed that apatinib and/or its accessories allergy;
3. Subjects with poor-controlled arterial hypertension (systolic blood pressure> 140 mmHg and diastolic blood pressure > 90 mm Hg) despite standard medical management;
4. Serious cardiovascular disease: Ⅱ-level myocardial ischemia or myocardial infarction, arrhythmia (including QT interval prolongation, for man ≥ 450 ms, for woman ≥ 470 ms); III ~ IV level cardiac function insufficiency, or echocardiography showed that left ventricular ejection fraction (LVEF < 50%);
5. Patients with positive urinary protein (urine protein detection of 2 or more, or 24 hour urine protein >1.0g);
6. Factors that could have an effect on oral medication (such as inability to swallow, chronic diarrhea and intestinal obstruction);
7. Subjects with high gastrointestinal bleeding risk, including the following conditions: local active ulcer lesions with positive fecal occult blood test (++); history of black stool, or vomiting blood in the past 2 months;unresected primary lesion in stomach with positive fecal occult blood test (+), ulcerated gastric carcinoma with massive alimentary tract bleeding risk judged by PIs based on gastric endoscopy result;
8. Abnormal Coagulation (INR>1.5、APTT>1.5 UNL), with tendency of bleed;
9. With psychotropic drug abuse history and can't get rid or with mental disorder patients;
10. Less than 4 weeks from the last clinical trial;
11. According to the researcher's judgment, with other serious diseases which harm to patient safety or affect patients complete the study;
12. Evidence of central nervous system(CNS) metastasis;
13. Pregnant or lactating women;
14. Other conditions regimented at investigators' discretion.