Apatinib for gastric cancer: are we moving the antiangiogenic strategy any forward?

Since patients with advanced gastric cancer (GC), a worldwide leading cause of cancer-related death, still have a dismal prognosis and a very limited 5-year life expectancy, novel treatment options are urgently needed. Although novel molecular classifications may help identifying potential targets, we have not reached major breakthroughs. The role of antiangiogenic strategy has recently contributed to reshape the overall management of advanced GC. Despite bevacizumab, the first clinically available VEGF-inhibitor, failed to provide convincing results in this disease, researchers did not give up. Ramucirumab, a recombinant monoclonal antibody that potently blocks VEGFR-2, was approved for clinical use based on the results of REGARD and RAINBOW studies. Apatinib, a novel orally active VEGFR-2 tyrosine kinase inhibitor, was lately tested in Chinese patients who had previously failed at least 2 systemic chemotherapies. In a recently published phase III, randomized, placebo-controlled trial, apatinib compared favorably to placebo in 273 heavily pretreated patients, and produced a 2-month increase in median overall survival (OS). Despite noteworthy, whether these results are practice changing and which degree of innovation they bring to the scientific community is still uncertain. Hopefully, ongoing studies will bring us the final picture in the near future.