Apatinib Combined With POF for Second-line Treatment of Gastric Adenocarcinoma

Inclusion Criteria:

• Patients with advanced unresectable, histologically confirmed adenocarcinoma of thegastric or gastroesophageal junction.

• Previous first-treatment with chemotherapy or radiation therapy failed. Ability totake medications orally. With measurable lesions. Patients must have a performancestatus of 0-1 on the Eastern Cooperative Oncology Group (ECOG) scale.

• Without serious system dysfunction and could tolerate chemotherapy. With normalmarrow, liver and renal function: a hemoglobin (HGB) of ≥100g/L (without bloodtransfusion during 14 days); a leucopenia count of ≥4.0×109/L; a platelet count of ≥100×109/L; a total bilirubin (TBil) of ≤1.5 upper normal limitation (UNL); acreatinine (Cr) of ≤ 1.5 UNL; a creatinine clearance rate ≥ 50ml/min (Cockcroft-Gault); a alanine aminotransferase (ALAT) and aspartate aminotransferase (ASAT) of ≤2.5 UNL or ≤5 UNL in case of liver metastasis.

• Life expectancy ≥3 months. With normal electrocardiogram results and no history ofcongestive heart failure.

• Without bleeding and thrombosis disease. With normal coagulation function: activatedpartial thromboplastin time (APTT), prothrombin time (PT) and INR, each ≤ 1.5 x ULN.

• Female subjects of child-bearing potential must agree to use contraceptive measuresstarting 1 week before the administration of the first dose of apatinib until 8 weeksafter discontinuing study drug. Male subjects must agree to use contraceptive measuresduring the study and 8 weeks after last dose of study drug With written informedconsent signed voluntarily by patients themselves or their supervisors witted bydoctors.

• With good compliance and agree to accept follow-up of disease progression and adverseevents.

Exclusion Criteria:

• Patients with a history of another neoplastic disease within the past three years,excluding basal cell carcinoma of the skin, cervical carcinoma in situ, ornonmetastatic prostate cancer.

• Patients with brain or central nervous system metastases, including leptomeningealdisease.

• Pregnant (positive pregnancy test) or breast feeding. Serious, non-healing wound,ulcer, or bone fracture. Significant cardiac disease as defined as: unstable angina,New York Heart Association (NYHA) grade II or greater, congestive heart failure,history of myocardial infarction within 6 months Evidence of bleeding diathesis orcoagulopathy.

• History of a stroke or CVA within 6 months. Clinically significant peripheral vasculardisease. Inability to comply with study and/or follow-up procedures. Patients with anyother medical condition or reason, in that investigator's opinion, makes the patientunstable to participate in a clinical trial.