OBJECTIVE: To systematically evaluate the efficacy and safety of increasing dose of apatinib mesylate in the treatment of advanced gastric cancer. METHODS: The Cochrane Library

Pub Med

EMBase

CNKI

Wanfang database and CBM database were retrieved to collect the randomized controlled trial of increasing dose of apatinib mesylate in the treatment of advanced gastric cancer（ the study group received apatinib mesylate orally with an incremental dosing regimen

while the control group was given apatinib mesylate orally at the regular dose recommended in the drug instructions）

the retrieval time was from the establishment of the databe to Feb. 2021. After literature screening

data extraction and evaluation of the risk of bias in the included literature

RevMan 5. 4 software was used for Meta-analysis. RESULTS: Totally 6 literature were collected

including 521 patients（ with 261 patients in the study group and 260 patients in the control group）. Meta-analysis results showed that the complete remission rate（ OR = 2. 32

95% CI = 1. 38-3. 91

P = 0. 002） and partial remission rate（ OR = 1. 68

95% CI = 1. 16-2. 43

P =0. 006）

remission rate（ OR = 2. 76

95% CI = 1. 80-4. 23

P < 0. 000 01）

progression rate（ OR = 0. 38

95% CI =0. 23-0. 62

P = 0. 000 1） and disease control rate（ OR = 2. 68

95% CI = 1. 64-4. 40

P < 0. 000 1） in the study group were significantly better than those in the control group

the differences were statistically significant. The incidence of urinary protein（ RD =-0. 06

95% CI =-0. 12--0. 00

P = 0. 04）

the incidence of hand-foot syndrome（ OR =0. 26

95% CI = 0. 16-0. 43

P < 0. 000 01）

the incidence of gastrointestinal reaction（ OR = 0. 22

95% CI = 0. 13-0. 37

P < 0. 000 01）

the incidence of gastrointestinal bleeding（ OR = 0. 26

95% CI = 0. 11-0. 64

P = 0. 003）

the incidence of abnormal liver function（ RD =-0. 07

95% CI =-0. 13--0. 01

P = 0. 02） and the incidence of hypertension（ RD =-0. 07

95% CI =-0. 13--0. 00

P = 0. 04） in the study group were significantly lower than those in the control group

and the differences were statistically significant. CONCLUSIONS: Available evidence suggests that increasing dose of apatinib mesylate is safe and effective in the treatment of advanced gastric cancer

with significant advantages over conventional dosing. The evidence for the results is limited by the number and quality of included literature

and the above findings need to be validated by additional high-quality studies.