Apatinib for Resectable Colorectal Cancer

1. ECOG performance status score: 0-1.
2. All colorectal cancer patients underwent curative intent surgery
3. Patients in stage Ⅱ(Any T, N0, M0) with multiple high-risk factors or stage Ⅲ (any T, N1-2, M0) which confirmed by pathology.
4. Patients who did not receive other treatments for colorectal adenocarcinoma after surgery;

5. The main organ function is good, patients must meet the following requirements with 14 days before using Apatinib:

   • blood routine examination:

     • hemoglobin> 90 g / L (14 days without blood transfusion);
     • neutrophil count> 1.5 x 109 / L;
     • platelet count> 100 × 109 / L;

   • biochemical examination:

     • total bilirubin ≤ 1.5 × ULN (normal upper limit);
     • alanine aminotransferase (ALT) or aspartate aminotransferase (AST) ≤ 2 × ULN;
     • Endogenous creatinine clearance ≥ 60 ml / min (Cockcroft-Gault formula);
   • Cardiac Doppler Ultrasonography: Left ventricular ejection fraction (LVEF) ≥ 50%.
6. The surgical incision has been healed, and no bleeding tendency;
7. Sign informed consent;
8. Compliance is good, family members agreed to accept survival follow-up.

Exclusion Criteria:

1. Patients with other malignancies, except for cured skin basal cell carcinoma and cervical cancer in situ.
2. Participated in other drug clinical trials within four weeks.
3. Have a variety of factors that affect oral medication (such as unable to swallow, chronic diarrhea and intestinal obstruction, etc.).
4. Have a history of bleeding, screening within 4 weeks before any serious grade to CTCAE4.0 3 degrees or more bleeding events.
5. Patients with central nervous system metastases or a history of central nervous system metastases before screening. For patients with suspected central nervous system metastases, CT or MRI examinations must be performed within 28 days prior to randomization to exclude central nervous system metastasis.
6. History of high blood pressure can not be controlled with a single antihypertensive drug therapy (With a systolic blood pressure> 140 mmHg, diastolic blood pressure> 90 mmHg. A history of unstable angina within 3 months or a new diagnosis of angina within 6 months (Including QTcF: male ≥ 450 ms, female ≥470 ms) required long-term use of antiarrhythmic drugs and New York Heart Association classification ≥ Class II cardiac insufficiency.
7. Urinary protein ≥ ++ and urine protein> 1.0 g in 24 hours.
8. Patients with anastomotic fistula, pancreatic fistula or anastomotic stenosis and other serious postoperative complications.
9. Long-term non-healing wounds or bone fractures.
10. history of organ transplantation.
11. Imaging shows that the tumor has involved important vascular. Patients in high risk of fatal bleeding during treatment.
12. coagulation abnormalities, with bleeding tendency (14 days before randomization must meet: in the absence of anticoagulants, INR in normal range). application of anticoagulants or vitamin K antagonists such as warfarin, (1 mg orally, once daily) or low-dose aspirin (1 mg or less daily) at a prokaryotic time (INR) ≤ 1.5 Daily consumption of not more than 100 mg).
13. During the last year, the history of tachycardia / venous thrombosis events, such as cerebrovascular accident (including transient ischemic attack), deep venous thrombosis (due to pre-chemotherapy intravenous thrombosis caused by intravenous thrombosis which have been cured ) And pulmonary embolism.
14. previous thyroid dysfunction, thyroid function can not be maintained within the normal range during medication.
15. with a history of psychiatric drug abuse and can not be prevented or have mental disorders.
16. Have a history of immunodeficiency, or suffer from other acquired, congenital immunodeficiency disease, or organ transplant history.
17. According to the researcher's judgment, there is a serious risk of compromising the patient's safety or affecting the patient's completion of the study.