S3135 Safety and Efficacy of Camrelizumab Combined With Apatinib for Advanced Gastric Cancer: A Systematic Review and Meta-Analysis

Introduction: Gastric cancer (GC), with 1.1 million new cases and 769,000 deaths annually, is a significant global health burden. Camrelizumab, a programmed cell death protein 1 inhibitor, combined with apatinib, a vascular endothelial growth factor receptor 2 inhibitor, enhances anti-tumor activity. This study evaluates the efficacy and safety of this combination in advanced GC. Methods: A literature search was conducted across PubMed, Cochrane, Embase, Scopus, and clinicaltrials.gov from inception until February 2025. Fourteen studies evaluating the safety and efficacy of camrelizumab plus apatinib for advanced GC were included. The analysis was conducted on RStudio v4.4.5. Pooled estimates were reported as proportions and 95% confidence interval (CI) using the random effect model. Statistical heterogeneity was assessed using I2. Subgroup analysis was conducted based on treatment exposure. Results: Five hundred sixty-four patients from 14 studies were included in the analysis. The pooled 1-year overall survival (OS) from 8 studies was 61% (95% CI 45-75; I2 = 81.4%), with significantly higher OS of 74% (60-86; P = 0.0092; I2 = 63.5%) in the treatment-naïve subgroup compared to the pretreated subgroup [45% (29-62; I2 = 63.1%). The pooled 1-year progression-free survival was 22% (6-45; I2 = 88.3%. Thirty-seven percent (95% CI 0.26-0.49; I2 = 0%) in the treatment-naïve and 14% (0-47; I2 = 91.1%) in the previously treated patients, with no statistical difference between the subgroups (P = 0.1717). The objective response rate was 43% (29-57; I2 = 86.2), also significantly higher in the treatment-naïve (55% [35-74]; P = 0.0450; I2 = 85.6%) versus previously treated patients (30% [17-44]; I2 = 78.4%). The pooled disease control rate was 87% (75-95; I2 = 89.3%), also notably greater in the treatment-naïve subgroup with 94% (84-100; I2 = 80.5%) compared to the previously treated subgroup at 74% (57-88; I2 = 85.9%), with a statistically significant subgroup difference (P = 0.0226). Overall, treatment-naïve status was consistently associated with improved clinical outcomes across all efficacy endpoints. Leukopenia (47%, 38-56), neutropenia (38%, 23-54), thrombocytopenia (35%, 24-48), aspartate aminotransferase elevation (32%, 19-47), alanine transaminase elevation (26%, 17-37), hand-foot syndrome (25%, 18-36), and hemangioma (25%, 18-36) were the most frequent adverse events. Conclusion: The combination of camrelizumab and apatinib demonstrates promising efficacy and manageable safety in advanced GC, particularly in treatment-naïve patients, offering a potential new treatment option for patients with limited therapeutic choices.