Efficacy and Feasibility of Modified Folfox as First-Line Chemotherapy in Elderly Patients with Metastatic or Recurrent Gastric Cancer

207 Background: Gastric cancer is the second causes of cancer-related deaths in the world and its incidence of advanced gastric cancer (AGC) in the elderly is increasing as a result of increased life expectancy. However, elderly patients have been underrepresented in many kinds of chemotherapy clinical trials. Therefore it is difficult to evaluate the efficacy and safety of chemotherapy for elderly patients and select the appropriate patients aged 70 years or older who are likely to benefit from the chemotherapy. Methods: There were 265 patients with primary unresectable or recurrent gastric cancer treated at our institution between April 2007 and March 2014. Of all, 90 patients aged 70 years or older were retrospectively identified. We evaluated the efficacy of the chemotherapy and prognostic significance of clinico-pathologic factors to identify the optimal indications for chemotherapy. Univariate and multivariate analyses were perfomed on the base-line characteristics such as patient’s performance status (PS), gender, chemotherapy regimens, history of gastrectomy, presense of co-morbidity, serum LDH level, serum C reactive protein, and nutritional status, at the initiation of the first-line chemotherapy. Results: The median overall survival time (OS) was 343 days and the median TTF on first-line chemotherapy was 111 days. The toxicity was mild and tolerable. There were no significant difference in overall survival between patients receiving monotherapy and combination therapy. On multivariate analyses, PS 1 or 2 (hazard ratio (HR), 1.883; 95% confidence interval (CI), 1.047–3.390), presence of primary tumor (HR, 1.916; 95% CI, 1.063–3.448) at the initiation of the first- line chemotherapy were identified as significant independent poor prognostic factors for overall survival. Especially in patients aged 75 years or older, only PS was an independent prognostic factor for OS (HR, 3.703; 95% CI, 1.314–9.900). Conclusions: Analysis of our results shows that patients aged 70 years or older with good performance status and absence of primary tumor might achieve clinical benefit from chemotherapy.

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Phase II trial of biweekly reduced-dose combination chemotherapy of oxaliplatin/5-fluorouracil/folic acid (Modified FOLFOX) as first-line chemotherapy in elderly patients with metastatic or recurrent gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15544 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15544-e15544

Author(s):

H. Kim ◽

B. Lee ◽

T. Kim ◽

S. Nam ◽

B. Kim

Keyword(s):

Gastric Cancer ◽

Folic Acid ◽

Elderly Patients ◽

Advanced Gastric Cancer ◽

Combination Chemotherapy ◽

First Line ◽

Reduced Dose ◽

Recurrent Gastric Cancer ◽

Dose Combination ◽

Line Chemotherapy

e15544 Background: Although combination chemotherapy as ECF (epirubicin, cisplatin, and 5-FU) and DCF (docetaxel, cisplatin, and 5-FU) are effective advanced gastric cancer, but it is too toxic to apply for elderly patients with increased comorbidity. Combination of oxaliplatin and 5-FU has proven to be a effective and tolerable regimen in advanced gastric cancer, and we investigated the efficacy and safety of reduced-dose combination chemotherapy of oxaliplatin/5-FU/folic acid as first-line chemotherapy in elderly patients with metastatic or recurrent gastric cancer. Methods: Elderly patients (≥60 years) with measurable, metastatic or recurrent gastric cancer were enrolled. Patients received oxaliplatin 75mg/m2 (2-hour intravenous infusion on D1), 5-FU 1000mg/m2 (12-hour continuous infusion on D1,2), and folic acid 20mg/m2 (15-minute infusion on D1,2) every 2 weeks. Results: Total 37 patients were enrolled between April 2004 and August 2008. Median age was 67 years old (range, 60 to 80 years), and 22 patients (59.5%) had increased Charlson comorbidity index score (CCI ≥1). Of 36 evaluable patients, 2 patients achieved complete response (CR), and 12 patients partial response (PR) with representing overall response rate of 44.4% (95% CI 27.7- 60.2). Stable disease (SD) was observed in 12 patients (33.3%), and progressive disease in 8 patients (22.3%). The median time to progression was 4.6 months, and median overall survival was 9.2 months. Relative dose intensity was 97.4% in both oxaliplatin and 5-FU. Grade 3 or 4 hematologic toxicities included neutropenia in one patients (2.7%), and anemia in three patients (8.1%). Peripheral neuropathy occurred (grade 2) was only observed in three patients (8.1%). Conclusions: The reduced-dose combination chemotherapy of oxaliplatin/5-FU/folic acid was effective and tolerable in elderly patients with metastatic or recurrent gastric cancer as first-line treatment. No significant financial relationships to disclose.

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P-087 A phase II study of a combination treatment of alternate-day S-1 and lentinan as first-line chemotherapy for unresectable or recurrent gastric cancer

Annals of Oncology ◽

10.1093/annonc/mdw199.84 ◽

2016 ◽

Vol 27 ◽

pp. ii26

Author(s):

S. Yoshino ◽

T. Nishimura ◽

K. Sakata ◽

S. Yoshida ◽

T. Furuya ◽

...

Keyword(s):

Gastric Cancer ◽

Phase Ii ◽

Combination Treatment ◽

Phase Ii Study ◽

First Line ◽

Recurrent Gastric Cancer ◽

Line Chemotherapy

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Comparison of efficacy and tolerance between combination therapy and monotherapy as first-line chemotherapy in elderly patients with advanced gastric cancer: Study protocol for a randomized controlled trial

Contemporary Clinical Trials Communications ◽

10.1016/j.conctc.2017.08.006 ◽

2017 ◽

Vol 8 ◽

pp. 55-61

Author(s):

Keun-Wook Lee ◽

Dae Young Zang ◽

Min-Hee Ryu ◽

Ki Hyang Kim ◽

Mi-Jung Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Randomized Controlled Trial ◽

Combination Therapy ◽

Elderly Patients ◽

Advanced Gastric Cancer ◽

Controlled Trial ◽

First Line ◽

Randomized Controlled ◽

Gastric Cancer Study ◽

Line Chemotherapy

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Oxaliplatin, 5-FU, Folinic Acid as First-line Palliative Chemotherapy in Elderly Patients with Metastatic or Recurrent Gastric Cancer

Cancer Research and Treatment ◽

10.4143/crt.2007.39.3.99 ◽

2007 ◽

Vol 39 (3) ◽

pp. 99 ◽

Cited By ~ 20

Author(s):

In Sil Choi ◽

Do-Youn Oh ◽

Byoung-Su Kim ◽

Keun-Wook Lee ◽

Jee Hyun Kim ◽

...

Keyword(s):

Gastric Cancer ◽

Elderly Patients ◽

Folinic Acid ◽

Palliative Chemotherapy ◽

First Line ◽

Recurrent Gastric Cancer

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A Phase II Study of Capecitabine plus Oxaliplatin as First-Line Chemotherapy in Elderly Patients with Advanced Gastric Cancer

Chemotherapy ◽

10.1159/000335585 ◽

2012 ◽

Vol 58 (1) ◽

pp. 1-7 ◽

Cited By ~ 15

Author(s):

Xiao Jun Xiang ◽

Ling Zhang ◽

Feng Qiu ◽

Feng Yu ◽

Zheng Yu Zhan ◽

...

Keyword(s):

Gastric Cancer ◽

Elderly Patients ◽

Advanced Gastric Cancer ◽

Phase Ii ◽

Phase Ii Study ◽

First Line ◽

Line Chemotherapy

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Feasibility of sequential fixed S-1 followed by paclitaxel for the treatment of advanced or recurrent gastric cancer

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.15113 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 15113-15113

Author(s):

M. Ohashi ◽

T. Kanda ◽

K. Yajima ◽

H. Honma ◽

S. Kosugi ◽

...

Keyword(s):

Gastric Cancer ◽

Treatment Time ◽

Performance Status ◽

Single Agent ◽

Line Treatment ◽

Second Line ◽

First Line ◽

Second Line Chemotherapy ◽

Recurrent Gastric Cancer ◽

Line Chemotherapy

15113 Background: First-line chemotherapy for advanced/recurrent gastric cancer has limited efficacy, achieving a median survival time (MST) of about 7 months, while addition of second-line and subsequent chemotherapy may prolong MST to about 11.5 months. In practice, however, about half of patients failing with first-line chemotherapy are unable to receive second-line chemotherapy because of worsening of their performance status (PS), disease progression, or toxicities during protracted first-line chemotherapy. We studied the feasibility of a sequential fixed regimen devised to ensure prompt initiation of second-line chemotherapy after first-line failure. Methods: Between December 2002 and December 2006, patients with advanced or recurrent gastric cancer were enrolled who met the following requirements: 1) major organ function preserved; 2) PS 0–2; 3) presence of at least one evaluable lesion; and 4) written informed consent. The treatment regimen consisted of 3 courses of single-agent S-1 or S-1/cisplatin combination followed by weekly paclitaxel (wPTX). The endpoints of the study were entry to the second-line treatment, time to failure (TTF), and MST. Results: Of 39 patients enrolled, 37 completed first- line S-1. Twenty-eight patients (76%) then received wPTX, 2 non-wPTX chemotherapy, and 6 surgery; only 1 received no additional treatments. Second-line wPTX was followed by a third-line treatment in 23/28 patients (82%). The TTF with the sequential fixed regimen was 7 months. The MST and the 1- and 2-year survival rates in the 37 completing first-line treatment were 14.6 months, 61% and 25%, while those in the 28 switched over to wPTX were 12.5 months, 51% and 17%. Conclusions: Patients with advanced/recurrent gastric cancer treated sequentially with a fixed number of courses of S-1 followed by wPTX may have a good chance of treatment continuation. A sequential fixed regimen may further improve survival of patients with advanced/recurrent gastric cancer only with combinations of currently available drugs. No significant financial relationships to disclose.

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