The impact of the difference in total diameter of metastatic tumor as a prognostic factor for advanced gastric cancer treated with systemic chemotherapy

Background: We previously reported tumor mutation burden (TMB) as a potential prognostic factor for patients with advanced gastric cancer (AGC) receiving immunotherapy. We aimed to comprehensively understand the impact of tumor burden and TMB on efficacy and prognosis in immunotherapy-treated AGC patients. Methods: A total of 58 patients with refractory AGC receiving PD-1 inhibitor monotherapy from a phase Ib/II clinical trial (ClinicalTrials.gov identifier: NCT02915432) were retrospectively included. Univariate and multivariate logistical regression analyses and the Cox proportional hazards model were performed for prognostic value of baseline factors. Factors reflecting baseline tumor burden, including baseline lesion number (BLN), the maximum tumor size (MTS) and the sum of target lesion size (SLS) were analyzed. The objective response rate (ORR) and disease control rate (DCR) were compared by Chi-square test. Results: In univariate analysis, high BLN was associated with poor median progression-free survival (mPFS) [1.7 months versus 3.4 months; hazard ratio (HR), 2.696, p < 0.05] and median overall survival (mOS) (3.2 months versus 7.6 months; HR, 1.997, p < 0.05), while high TMB was a positive prognostic factor. In multivariable analysis, both BLN and TMB were independent prognostic factors for mOS (BLN: HR, 2.782, p < 0.05; TMB: HR, 0.288, p < 0.05), while MTS or SLS had no association with survival. Better ORR and DCR were observed in the low BLN group (15.4% versus 5.3%, p > 0.05; 86.96% versus 54.29%, p < 0.05). When combining BLN and TMB, the best efficacy and survival were observed in the BLNlowTMBhigh group (ORR: 37.5%, DCR: 62.5%, mPFS and mOS: not reached). The worst efficacy and survival were shown in the BNLhighTMBlow group [ORR: 0% (0/15); DCR: 13.3%; mPFS: 1.7 months; mOS: 2.7 months (all p < 0.05)]. Conclusions: BLN, rather than factors regarding baseline tumor size, is perhaps a potential predictor for benefit from immunotherapy and its combination with TMB could further risk-stratify patients with AGC receiving immunotherapy.

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Analysis of weight loss as a prognostic factor in patients (pts) with advanced gastric cancer from REGARD, RAINBOW and RAINFALL phase III studies.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.348 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 348-348

Author(s):

Wasat Mansoor ◽

Eric Roeland ◽

Aafia Chaudhry ◽

Ran Wei ◽

Anindya Chatterjee ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Advanced Gastric Cancer ◽

Meta Analysis ◽

Phase Iii ◽

Phase 3 ◽

Nutritional Interventions ◽

Negative Prognostic Factor ◽

Three Phase ◽

The Impact

348 Background: Maintaining weight (wt) and adequate nutrition during systemic treatment in advanced gastric cancer (G/GEJ) therapy remains a challenge. We investigated the impact of early wt-loss on survival in three phase 3 studies of ramucirumab (R); REGARD (RG), RAINBOW (RB), and RAINFALL (RF) in G/GEJ. Methods: ITT pts were categorized into 2 groups based on their body wt change from start to end of cycle 1 (C1; C = 28 days in RG, RB; C = 21 days in RF): wt-loss < 3% vs ≥3%. Univariate Cox PH models were performed in each individual study to evaluate the effects of body wt change from the start to end of C1 on OS. A pooled meta-analysis stratified by study and a sensitivity analysis of the subgroup of responders was also performed. Results: A total of 311 (RG: 212 in R+BSC; 99 in Placebo (PB)+BSC), 591 (RB: 306 in the R+Paclitaxel (P); 285 PB+P), and 562 (RF: 279 in R+Cape/Cis (CC); 283 in PB+CC) pts with body wt data during C1 were evaluated. The number of pts with wt-loss of ≥3% and < 3% are shown in Table. Pts with wt-loss < 3% during C1 experienced longer OS compared to those with wt-loss ≥3%, irrespective of treatment arms across studies (Table). In pooled treatment arms within each study, the HR for wt-loss group ( < 3% vs ≥3%) was 0.359 (95% CI = 0.254, 0.507), 0.632 (0.497, 0.804), 0.752 (0.608, 0.930) in RG, RB, RF, respectively. In the meta-analysis that combined the 3-studies, univariate Cox PH model stratified by study showed consistent effect of early wt-loss on OS regardless of treatment arm, HR ( < 3% vs ≥3%) = 0.632 (0.546, 0.732). Conclusions: Analysis from three phase 3 studies demonstrates early wt-loss ≥3% during C1 is an important negative prognostic factor for survival in gastric/GEJ cancer. Prospective studies of the relationship of weight preserving nutritional interventions on OS are warranted. Clinical trial information: NCT00917384, NCT01170663, NCT02314117. [Table: see text]

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The impact of the extent of gastric resection on advanced gastric cancer treated with systemic chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.194 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 194-194

Author(s):

Yusuke Sasaki ◽

Yutaka Watanabe ◽

Ichiro Ohkita ◽

Jojo Hirota ◽

Jun Konno

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Systemic Chemotherapy ◽

Gastric Resection ◽

Stage Iv ◽

Patient Characteristics ◽

Severe Toxicity ◽

Stage Iv Gastric Cancer ◽

Significant Difference ◽

The Impact

194 Background: In previous clinical trials of adjuvant chemotherapy for gastric cancer, severe toxicity and discontinuation of chemotherapy was more common in patients receiving total gastrectomy (TG) than in those with distal gastrectomy (DG). However, data on the significance of the extent of gastric resection for stage IV gastric cancer treated with systemic chemotherapy are not available. Methods: This is a retrospective review of patients who were received chemotherapy with S-1 and cisplatin for stage IV gastric cancer at our institution between June 2009 and August 2015. The patients were classified into three groups according to the extent of gastrectomy (TG, DG and no gastric resection (NG)) before chemotherapy. Patient characteristics, survival and toxicities of chemotherapy were compared between three groups. Results: Among the 83 patients, 24 underwent TG, 19 DG, and 40 NG. Patient characteristics were well balanced between three groups. There was no significant difference in the requirement for dose reduction between TG, DG and NG patients (29% vs 11% vs 20%, respectively, p= 0.32). However, the rate of discontinuation because of toxicity was significantly higher in TG than in DG or NG patients (46% vs 16% vs 25%, respectively, p= 0.04). The main reasons of discontinuation were anorexia (43%), myelosuppression (23%), nausea (18%) and diarrhea (16%). The median progression-free survival was 8.9, 6.1 and 5.3 months ( p= 0.25), and the median overall survival was 16.0, 16.0 and 9.8 months ( p= 0.40) in the patients with TG, DG and NG, respectively. Conclusions: There was a high frequency of discontinuation of systemic chemotherapy in the advanced gastric cancer patients who underwent TG, but it was not associated with prognosis.

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Use of inflammation-based prognostic score to predict survival in patients with advanced gastric cancer receiving biweekly docetaxel and S-1 combination chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.e14624 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. e14624-e14624

Author(s):

Chikara Kunisaki ◽

Masazumi Takahashi ◽

Hidetaka Ono ◽

Takashi Oshima ◽

Shoichi Fujii ◽

...

Keyword(s):

Gastric Cancer ◽

Prognostic Factor ◽

Advanced Gastric Cancer ◽

Cancer Patients ◽

Prognostic Score ◽

Univariate Analysis ◽

Prospective Trial ◽

Hazard Model ◽

Gastric Cancer Patients ◽

The Impact

e14624 Background: The Glasgow Prognostic Score (GPS), an inflammation-based prognostic score composed of C-reactive protein (CRP) and albumin measurements, has been reported to be a prognostic factor in patients with various cancers. This study was conducted to determine the prognostic value of GPS for patients with advanced cancer. Methods: The GPS was classified according to a previous study. A total of 83 advanced gastric cancer patients receiving bi-weekly docetaxel/S1 treatment (DS) were included. Correlation of clinicopathological factors and the GPS was assessed. To identify the impact of GPS as prognostic factors for disease-specific survival (DSS) and progression-free survival (PFS), univariate and multivariate analyses were performed. Results: Of these 83 patients, unresectable tumors were observed in 78 patients and recurrent tumors were detected in 5 patients. Of these, 13 patients underwent surgery and 12 patients underwent gastrectomy. There were significant correlations between the GPS and the neutrophil to lymphocyte ratio (NLR). Univariate analysis revealed that the GPS, ECOG-PS and gastrectomy after DS treatment significantly affected prognosis. The Cox proportional regression hazard model showed that the GPS, age and gastrectomy independently influenced DSS, and that the GPS and gastrectomy also influenced PFS. The Cox proportional regression hazard model restricted patients without gastrectomy showed that the GPS and age independently influenced DSS, and that the GPS influenced PFS. Conclusions: The GPS may be an useful prognostic factor for advanced gastric cancer patients receiving uniform first-line treatment (DS). The impact of the GPS should be confirmed in a well-designed prospective trial in many patients.

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Long-Term Survival of Two Patients with Liver Metastases from Advanced Gastric Cancer Treated with Radiofrequency Ablation and Chemotherapy

Case Reports in Oncology ◽

10.1159/000507849 ◽

2021 ◽

pp. 67-72

Author(s):

Sung Jin Oh

Keyword(s):

Gastric Cancer ◽

Radiofrequency Ablation ◽

Liver Metastases ◽

Advanced Gastric Cancer ◽

Systemic Chemotherapy ◽

Subtotal Gastrectomy ◽

Hepatic Metastases ◽

Term Survival ◽

Long Term Survival

Liver metastasis from gastric cancer has a very poor prognosis. Herein, we present two cases of liver metastases (synchronous and metachronous) from advanced gastric cancer. In the first case, the patient underwent radical subtotal gastrectomy. Liver metastases occurred 6 months after surgery while the patient was receiving adjuvant chemotherapy, but two hepatic tumors were successfully removed by radiofrequency ablation (RFA). In the second case, liver metastases occurred 15 months after surgery for gastric cancer. The patient also received RFA for one hepatic tumor, and other suspicious metastatic tumors were treated with systemic chemotherapy. Although these case presentations are limited for the efficacy of RFA treatment with systemic chemotherapy for hepatic metastases from gastric cancer, our findings showed long-term survival (overall survival for 108 and 67 months, respectively) of the affected patients, without recurrence. Therefore, we suggest that RFA treatment with systemic chemotherapy could be an effective alternative treatment modality for hepatic metastases from gastric cancer.

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