A Clinical Trial of Apatinib Plus Docetaxel in Locally Advanced or Metastatic Gastric or GEJ Adenocarcinoma

1. Patient has to voluntarily join the study and sign the Informed Consent Form for the study;
2. Age: ≥18 years old;

3. Locally advanced or metastatic gastric cancer (including Gastroesophageal junction (GEJ) Adenocarcinoma ) patients confirmed by radiologic imaging or endoscopy tests, who had failed in first-line treatments;

   • First-line treatment should be 5-Fu combined with platinum based regimen;
   • Adjuvant/neoadjuvant chemotherapy should be defined as the first-line treatment, if recurrence happened within 6 months after completion of 5-Fu and platinum based adjuvant/ neoadjuvant chemotherapy;
4. Adjuvant/neoadjuvant chemotherapy history is allowed, if first-line treatment is applied more than 6 months later than prior treatments;
5. Willingness and ability to comply with scheduled visits, treatment plans, laboratory tests, and other study procedure;
6. ECOG Performance Status ≤1;
7. Life expectancy shouldn't less than 16 weeks, since the first medicine application time;

8. Major organ function has to meet the following criteria (within 28 days before treatment):

   • HB ≥9.0 g/dL
   • ANC ≥1.5X109/L
   • PLT ≥100x109/L
   • Bilirubin ≤1.5 times the upper limit of normal (ULN)
   • ALT (SGOT) and AST (SGPT) ≤2.5 × ULN, unless liver metastases; if any, the ALT and AST≤5 × ULN
   • Serum Cr ≤ 1.5 x ULN
9. Patients must have at least one assessable lesion (including measurable and/or immeasurable) by radiological imagine (CT/MRI);

10. Pregnancy test (serum or urine) has to be performed for woman of childbearing age within 28 days before enrollment and the test result must be negative. Or menopause women, defined as follow:

    • ≥1 year no menstruation, after abort exogenous hormone treatment
    • Serum LH and FSH meet menopause criteria
    • More than 1 year no menstruation for ovarian function failure induced by radiation therapy.
    • More than 1 year no menstruation for menopause induced by chemotherapy
    • Surgical sterilization accepted (hysterectomy or ovariectomy)

Exclusion Criteria:

1. Involved in another on-going clinical trials;
2. Accept more than one chemotherapy previously in advanced gastric cancer (except more than 6 months from adjuvant/neoadjuvant treatment);
3. Prior taxane treatment (including Paclitaxel and Docetaxel);
4. Prior VEGFR inhibitor treatment (including Sorafenib and Sunitinib);
5. History of another malignancy within the last five years except cured nonmelanoma Skin cancer and carcinoma in situ of uterine cervix;
6. Any factors that influence the usage of oral administration;
7. History of the investigational agent treatment in 14 day prior to enroll in study (longer time period may be required which depends on drug characteristic);
8. Accept any chemotherapy and radiotherapy (excluding Palliative radiotherapy) in 3 weeks prior to study (longer time period may be required which depends on drug characteristic);
9. Poor-controlled arterial hypertension (systolic blood pressure> 140 mmHg and diastolic blood pressure > 90 mm Hg) despite standard medical management; Coronary heart disease greater than Class I; I-level arrhythmia (including QT interval prolongation, for man ≥ 450 ms, for woman ≥ 470 ms) together with Class I cardiac dysfunction; Patients with positive urinary protein;
10. Poor-controlled adverse events (excluding Alopecia) induced by tumor therapy (>class 1 CTCAE);
11. History of intestinal obstruction or more than class 3 or 4 (CTCAE) gastrointestinal bleeding in 4 weeks prior to enroll in study;
12. Abnormal Coagulation (INR>1.5、APTT>1.5 UNL), with tendency of bleed;
13. Clinical evidence in central nervous system (CNS) and poor-controlled CNS metastasis (No necessary to confirm negative CNS metastasis by CT/MRI);
14. Surgery within 2 weeks prior to enroll in study;
15. History of significant and poor-controlled diseases or infection, in the opinion of investigators, may impact the safety of the patients of the study;
16. Known history of human immunodeficiency, e.g. HIV positive;
17. Known or suspected allergy to the investigational agent or any agent given in association with this trial;
18. Pregnant or lactating patients.