Apatinib in the Treatment of Advanced Non-squamous Non-small Cell Lung Cancer

• Objective Response Rate(ORR) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  ORR was the percentage of patients who got partial or complete response
• Overall Survival(OS) [ Time Frame: 24 months ] [ Designated as safety issue: No ]
  OS was determined from date of enrollment until death or the date the patient was recorded alive of last follow-up
• Toxicity [ Time Frame: 24 months ] [ Designated as safety issue: Yes ]
  Adverse events (AEs) were recorded, graded for toxicity using the NCI-CTC, and assessed by the investigator for any relationship with treatment.

• Objective Response Rate(ORR) [ Time Frame: 36 months ] [ Designated as safety issue: No ]
  ORR was the percentage of patients who got partial or complete response
• Overall Survival(OS) [ Time Frame: 36 months ] [ Designated as safety issue: No ]
  OS was determined from date of enrollment until death or the date the patient was recorded alive of last follow-up
• Toxicity [ Time Frame: 36 months ] [ Designated as safety issue: Yes ]
  Adverse events (AEs) were recorded, graded for toxicity using the NCI-CTC, and assessed by the investigator for any relationship with treatment.

Apatinib is a new kind of Vascular endothelial growth factor receptor(VEGFR) tyrosine kinase inhibitors (TKIs). The investigators have finished the preclinical and phase I and phase II clinical study for apatinib and found its satisfactory anti-tumor activity and tolerated toxicities. A disease-control rate of 75% was found in lung cancer patients. In the present phase III trial, the investigators will further evaluate the efficacy and toxicities of apatinib in the treatment of advanced non-squamous non-small cell lung cancer.

• Drug: apatinib
  750 mg，po，QD； 28 days every cycle
• Drug: placebo
  po，QD； 28 days every cycle

• Experimental: Apatinib
  750 mg，po，QD； 28 days every cycle
  Intervention: Drug: apatinib
• Placebo Comparator: Placebo
  Intervention: Drug: placebo

Inclusion Criteria:

1. Patients 18 to 70 years of age
2. Documented pathological evidence of advanced non-squamous non-small cell lung cancer with measurable lesions
3. Failure of epidermal-growth-factor receptor (EGFR) TKIs target treatment and second-line or more regimens of chemotherapy
4. Eastern Cooperative Oncology Group (ECOG) performance status between 0 and 1
5. Patients had to have recovered from any toxic effects of therapy
6. Patients with brain/meninges metastasis should keep stable disease for 2 months before randomisation
7. Adequate hematologic and biochemical values were required

Exclusion Criteria:

1. Presence of small-cell lung cancer alone or with NSCLC
2. Pregnant or breast-feeding women
3. Severe or uncontrolled systemic disease such as clinically significant hypertension(systolic pressure > 140 mmHg，diastolic pressure > 90 mmHg), cardiac ischemia and infarction, ventricular arrhythmias(QT ≥ 440ms) and grade 1 cardiac insufficiency
4. Difficulties in taking pills (inability to swallow tablets,GI tract resection, chronic bacillary diarrhea and intestinal obstruction)
5. Coagulation disfunction,hemorrhagic tendency or receiving anticoagulant therapy
6. ≥ CTCAE 2 pneumorrhagia or ≥ CTCAE 3 hemorrhage in other organs within 4 weeks
7. Bone fracture or wounds that was not cured for a long time
8. Arterial thrombus or phlebothrombosis within 6 months and taking anticoagulant agents
9. Mental diseases and psychotropic substances abuse
10. Previous treatment with an experimental agent within 4 weeks
11. Previous treatment with VEGFR、platelet derived growth factor receptor(PDGFR) TKIS
12. Other coexisting malignant disease (apart from basal-cell carcinoma and carcinoma in situ of uterine cervix)