Efficacy and safety of apatinib-containing neoadjuvant regimens for resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and single-arm meta-analysis
- 1Department of Thoracic Surgery, The Second Hospital of Jilin University
- 2Department of Gastrointestinal Medicine, The First Hospital of Jilin University
Abstract
Background: Perioperative chemotherapy remains the standard-of-care for resectable gastric and gastroesophageal junction (G/GEJ) adenocarcinoma, yet pathologic complete response (pCR) rates remain low and long-term survival is suboptimal. Apatinib has shown efficacy in advanced G/GEJ cancer, but its role and optimal combination regimens in the neoadjuvant setting remain unclear, and no quantitative evidence synthesis has been published. This systematic review and single-arm meta-analysis aimed to evaluate the efficacy and safety of neoadjuvant apatinib-based regimens for resectable G/GEJ adenocarcinoma.
Methods: A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, and major oncology conference proceedings up to January 1, 2026. Single-arm studies reporting neoadjuvant apatinib-based therapy for resectable G/GEJ adenocarcinoma were included. Primary outcomes were pCR rate, major pathologic response (MPR) rate, R0 resection rate, objective response rate (ORR), and disease control rate (DCR); secondary outcomes were grade ≥3 treatment-related adverse events (TRAEs) and postoperative complications. Pooled proportions with 95% confidence intervals were calculated using logit-transformed single-arm meta-analysis; random- or fixed-effects models were selected based on between-study heterogeneity (I²). Analyses were performed in R, Review Manager 5.4, and Stata 17.0.
Results: Twenty studies enrolling 1026 patients with resectable G/GEJ cancer were initially included. After excluding one potentially overlapping cohort (Jianxian Lin 2024, n=51), 19 studies with 975 patients were included in the primary analysis. The pooled pCR rate of neoadjuvant apatinib-based therapy was 21% (95% CI: 18%–25%, I² = 19.4%), and the pooled major pathologic response (MPR) rate was 39% (95% CI: 34%–45%, I² = 37.8%). The R0 resection rate reached 93% (95% CI: 90%–95%, I² = 37.6%), with an objective response rate (ORR) of 70% (95% CI: 66%–74%, I² = 24.4%) and a disease control rate (DCR) of 95% (95% CI: 92%–96%, I² = 0%). The overall incidence of grade ≥3 treatment-related adverse events (TRAEs) was 31% (95% CI: 21%–43%, I² = 80.1%), and the pooled rate of postoperative complications was 27% (95% CI: 22%–32%, I² = 44.6%). In exploratory subgroup analysis, pCR rates were 12% in the nACT group and 22% in the nAICT group, with similar directional differences observed in MPR, ORR, and R0 resection; however, these were indirect, non-randomized comparisons and are presented descriptively as hypothesis-generating.
Conclusion: This meta-analysis reports that neoadjuvant apatinib-containing regimens are associated with a pooled pCR rate of 21%, MPR rate of 39%, R0 resection rate of 93%, and DCR of 95%. These descriptive estimates suggest that apatinib-containing neoadjuvant therapy is feasible in selected patients and warrants further investigation in randomized controlled trials. However, because the evidence is predominantly non-comparative and heterogeneous, no conclusion regarding comparative efficacy or safety superiority over conventional therapy can be drawn.
Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42023478481.
Related
- Neoadjuvant immunotherapy for locally advanced resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and meta-analysis.
- Umbrella review of meta-analyses: perioperative immune checkpoint inhibitor therapy in resectable gastric and gastroesophageal junction adenocarcinoma
- Immune checkpoint inhibitors across neoadjuvant, perioperative, and adjuvant settings for resectable non-small-cell lung cancer: a systematic review and meta-analysis of randomized trials
- Long-Term Outcomes of Anatomical and Biological Borderline Resectable Pancreatic Ductal Adenocarcinoma After Gemcitabine/S-1-Based Neoadjuvant Chemoradiotherapy
- Efficacy comparison of neoadjuvant chemotherapy, chemoradiotherapy, and chemoimmunotherapy in resectable esophageal squamous cell carcinoma: short- and long-term outcomes from a propensity score-matched analysis
BibTeX
@article{xin2026efficacy,
title = {{Efficacy and safety of apatinib-containing neoadjuvant regimens for resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and single-arm meta-analysis}},
author = {Kaiyi Xin and Zhilu Chen and Liu Yang and Li Qin and Shu Chen and Tianjiao Xiao and Yinghao Zhao},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1910490},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1910490/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Efficacy and safety of apatinib-containing neoadjuvant regimens for resectable gastric and gastroesophageal junction adenocarcinoma: a systematic review and single-arm meta-analysis
AU - Kaiyi Xin
AU - Zhilu Chen
AU - Liu Yang
AU - Li Qin
AU - Shu Chen
AU - Tianjiao Xiao
AU - Yinghao Zhao
PY - 2026
DA - 2026/10/19
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1910490
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1910490/full
AB - Background: Perioperative chemotherapy remains the standard-of-care for resectable gastric and gastroesophageal junction (G/GEJ) adenocarcinoma, yet pathologic complete response (pCR) rates remain low and long-term survival is suboptimal. Apatinib has shown efficacy in advanced G/GEJ cancer, but its role and optimal combination regimens in the neoadjuvant setting remain unclear, and no quantitative evidence synthesis has been published. This systematic review and single-arm meta-analysis aimed to evaluate the efficacy and safety of neoadjuvant apatinib-based regimens for resectable G/GEJ adenocarcinoma. Methods: A systematic literature search was conducted across PubMed, Embase, the Cochrane Library, Web of Science, and major oncology conference proceedings up to January 1, 2026. Single-arm studies reporting neoadjuvant apatinib-based therapy for resectable G/GEJ adenocarcinoma were included. Primary outcomes were pCR rate, major pathologic response (MPR) rate, R0 resection rate, objective response rate (ORR), and disease control rate (DCR); secondary outcomes were grade ≥3 treatment-related adverse events (TRAEs) and postoperative complications. Pooled proportions with 95% confidence intervals were calculated using logit-transformed single-arm meta-analysis; random- or fixed-effects models were selected based on between-study heterogeneity (I²). Analyses were performed in R, Review Manager 5.4, and Stata 17.0. Results: Twenty studies enrolling 1026 patients with resectable G/GEJ cancer were initially included. After excluding one potentially overlapping cohort (Jianxian Lin 2024, n=51), 19 studies with 975 patients were included in the primary analysis. The pooled pCR rate of neoadjuvant apatinib-based therapy was 21% (95% CI: 18%–25%, I² = 19.4%), and the pooled major pathologic response (MPR) rate was 39% (95% CI: 34%–45%, I² = 37.8%). The R0 resection rate reached 93% (95% CI: 90%–95%, I² = 37.6%), with an objective response rate (ORR) of 70% (95% CI: 66%–74%, I² = 24.4%) and a disease control rate (DCR) of 95% (95% CI: 92%–96%, I² = 0%). The overall incidence of grade ≥3 treatment-related adverse events (TRAEs) was 31% (95% CI: 21%–43%, I² = 80.1%), and the pooled rate of postoperative complications was 27% (95% CI: 22%–32%, I² = 44.6%). In exploratory subgroup analysis, pCR rates were 12% in the nACT group and 22% in the nAICT group, with similar directional differences observed in MPR, ORR, and R0 resection; however, these were indirect, non-randomized comparisons and are presented descriptively as hypothesis-generating. Conclusion: This meta-analysis reports that neoadjuvant apatinib-containing regimens are associated with a pooled pCR rate of 21%, MPR rate of 39%, R0 resection rate of 93%, and DCR of 95%. These descriptive estimates suggest that apatinib-containing neoadjuvant therapy is feasible in selected patients and warrants further investigation in randomized controlled trials. However, because the evidence is predominantly non-comparative and heterogeneous, no conclusion regarding comparative efficacy or safety superiority over conventional therapy can be drawn. Systematic review registration: https://www.crd.york.ac.uk/prospero/ , identifier CRD42023478481.
SN - 2234-943X
ER -