Efficacy and prognostic factor analysis in second-line chemotherapy for elderly patients with metastatic gastric cancer.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 143-143
Author(s):  
Ayaka Shoji ◽  
Hiroko Hasegawa ◽  
Seiya Kato ◽  
Ryosuke Kiyota ◽  
Kazuma Shinkai ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Prognostic Factors ◽  
Elderly Patients ◽  
Progression Free Survival ◽  
Metastatic Gastric Cancer ◽  
The Other ◽  
Second Line ◽  
Eligibility Criteria ◽  
Second Line Chemotherapy ◽  
Line Chemotherapy

143 Background: Recently, the proportion of elderly patients (pts) with advanced gastric cancer has increased in Japan. Survival benefits of second-line chemotherapy (CTX) such as weekly paclitaxel (PTX)±Ramucirumab (RAM) or irinotecan (CPT) were shown in several phase 3 trials for metastatic gastric cancer (mGC). However, efficacy and prognostic factors in the second line CTX for elderly pts are not well studied. Methods: We retrospectively reviewed for mGC pts aged ≥ 70 years who underwent PTX+RAM, PTX or CPT as second-line CTX. Eligibility criteria were as follows: PS 0-2, refractory to an S-1containing CTX. Response rate (RR), overall survival (OS), progression-free survival (PFS), and adverse events (AEs) were evaluated. Univariate and multivariate analyses were performed to determine prognostic factors of survival. Results: There were 250 pts with mGC treated at our institution between April 2007 and March 2017. Of all, total of 85 pts were eligible. Median age was 75 years (71-85). The RR was 28.0% in the PTX+RAM group (n=28), 17.2% in the PTX group (n=29) and 18.5% in the CPT group (n=28). Median PFS was 5.1 months(M) and MST was 12.2 M in the PTX+RAM group, compared with 4.1 M and 9.7 M in the PTX group, or 3.3M and 9.8M in the CPT group. The ORR, PFS and OS were better in the PTX+RAM group though differences between groups were not statistically significant. Grade 3 or higher non-hematological AEs such as fatigue or diarrhea were more frequent in the CPT group on the other hand, hematological AEs were more frequent in the PTX+RAM group. On multivariate analysis, PS (HR,3.13; 95%CI, 1.60-5.77), LDH (HR,3.19; 95%CI, 1.80-5.57), and CEA (HR,2.35; 95%CI, 1.30-4.16) were found to be significant prognostic factors for elderly pts with mGC who underwent second-line CTX. Conclusions: PTX+RAM therapy seemed to be more effective than the other regimens. Furthermore, this analysis for prognostic factors may help clinicians to better select elderly pts who may benefit from a second-line CTX.

Second-line chemotherapy with paclitaxel for elderly patients with advanced gastric cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 108-108 ◽  
Author(s):  
Akihiro Ohba ◽  
Atsuo Takashima ◽  
Takamasa Nishiuchi ◽  
Yoshitaka Honma ◽  
Satoru Iwasa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adverse Events ◽  
Elderly Patients ◽  
Advanced Gastric Cancer ◽  
Progression Free Survival ◽  
The Elderly ◽  
Elderly Group ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Line Chemotherapy

108 Background: Survival benefits of second-line chemotherapy such as weekly paclitaxel (wPTX) for patients with advanced gastric cancer (AGC) were shown in several phase 3 trials. However, these trials included a small proportion of elderly patients, and few elderly patients receive second-line therapy in clinical practice. The aim of this study was to compare the efficacy and safety of second-line chemotherapy with wPTX between elderly and non-elderly patients. Methods: The subjects of this retrospective study were AGC patients who received wPTX as second-line chemotherapy between January 2002 and August 2014, fulfilling the following selection criteria; 1) pathologically proven metastatic or recurrent gastric adenocarcinoma, 2) receipt of wPTX after platinum or fluoropyrimidine containing chemotherapy. Patients were divided into two groups by age: ≥ 75 years old (elderly group) and < 75 years old (non-elderly group). Response rate (RR) in patients with measurable lesions, overall survival (OS), progression-free survival (PFS), post-progression survival (PPS) and adverse events were evaluated. Hazard ratios of survival were adjusted by prognostic factors using Cox proportional hazard model. Results: A total of 272 patients, 31 elderly and 241 non-elderly, were selected in this study. RRs were 6.2% (1/16) in the elderly group and 12.7% (15/118) in the non-elderly group (p = 0.69). While PFS was similar between two groups (median 2.4 vs. 3.6 months, adjusted hazard ratio [HR] 1.18, p = 0.46), the elderly group showed shorter OS than the non-elderly group (median 5.1 vs. 6.1 months, adjusted HR 1.49, p = 0.06), associated with relatively shorter PPS (median 2.2 vs. 2.6 months, adjusted HR 1.40, p = 0.11). There were no remarkable differences in the incidences of grade 3 or higher adverse events between the two groups (hematologic 38.7 vs. 41.1%; non-hematologic 25.8 vs. 23.7%). No treatment related deaths were observed in either group. Third-line chemotherapy was administered in 19.4% of elderly group and 35.3% of non-elderly group (p = 0.11). Conclusions: It is suggested that second-line chemotherapy with wPTX for AGC may be tolerable and have some clinical benefits for elderly patients as well as for non-elderly patients.

Correlation between overall survival and other endpoints in clinical trials of second-line chemotherapy for patients with advanced gastric cancer.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 4067-4067
Author(s):  
Kohei Shitara ◽  
Keitaro Matsuo ◽  
Kei Muro ◽  
Atsushi Ohtsu
Keyword(s):  
Gastric Cancer ◽  
Overall Survival ◽  
Advanced Gastric Cancer ◽  
Rank Correlation ◽  
Progression Free Survival ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Randomized Studies ◽  
Low Correlation ◽  
Line Chemotherapy

4067 Background: The correlation between progression-free survival (PFS) or time to progression (TTP) and overall survival (OS) has been evaluated in patients with advanced gastric cancer (AGC) who received first-line chemotherapy (Shitara, K et al. Invest New Drug 2011; Shitara K and Burzykowski T, et al, ASCO 2011). However, no corresponding analysis had been done in patients who underwent second-line chemotherapy for AGC. Methods: We evaluated the potential of PFS, TTP, response rate (RR), or disease control rate (DCR) to act as surrogates for OS in phase II and III trials of second-line chemotherapy for AGC by comprehensive literature-based analysis. Correlations between each endpoint and OS were evaluated by Spearman rank correlation coefficient (ρ). Subgroup analyses by trial region or type of failure to previous chemotherapy were also conducted. Results: Fifty-six trials, including four randomized studies, were selected for analysis and covered a total of 61 treatment arms and 3,038 patients; 34 studies were conducted in Asia, 20 studies in Non-Asian countries, and two studies in both regions. Median PFS were similar in Asian and Non-Asian trials (3.0 vs. 3.3 months). In contrast, median OS tended to be longer in Asian vs. Non-Asian trials (8.0 vs. 6.0 months; p<0.01). Median PFS/TTP and OS showed a moderate correlation with ρ of 0.51 (95% CI, 0.31-0.73). Correlation tended to be higher in PFS (ρ = 0.62) than TTP (ρ = 0.29) and higher in non-Asian trials (ρ = 0.73) than Asian trials (ρ = 0.32). Correlation between PFS/TTP and OS among the trials in which eligibility required failure to previous fluorouracil and cisplatin also showed low correlation (ρ = 0.48). The RR and DCR also did not show high correlation with OS (ρ = 0.30 for RR; 95% CI 0.04-0.56; ρ = 0.53 for DCR; 95% CI 0.31-0.75). The hazard ratio (HR) of PFS and OS in each arms of the four randomized studies showed a low correlation with ρ of 0.10. Conclusions: Our results indicate that PFS/TTP, RR, and DCR did not correlate sufficiently with OS to be used as surrogate endpoints in patients with AGC who underwent second-line chemotherapy. Further research is needed based on individual patient data from ongoing randomized trials.

Tumor angiogenesis genotyping and efficacy of first-line chemotherapy in metastatic gastric cancer patients.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 64-64
Author(s):  
Mario Scartozzi ◽  
Riccardo Giampieri ◽  
Cristian Loretelli ◽  
Alessandro Bittoni ◽  
Alessandra Mandolesi ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Cancer Patients ◽  
Metastatic Gastric Cancer ◽  
Second Line ◽  
Tumour Angiogenesis ◽  
First Line ◽  
Altered Expression ◽  
Second Line Chemotherapy ◽  
Gastric Cancer Patients ◽  
Line Chemotherapy

64 Background: An altered expression of tumour angiogenesis-related factors has been constantly associated to a more aggressive phenotype and an increased relapse rate in several tumour types, including gastric cancer. Besides correlating with prognosis, tumour-driven angiogenesis seemed also able to influence response/resistance to chemotherapy in pre-clinical models. We examined the role of tumour angiogenesis genotyping in determining clinical outcome in metastatic gastric cancer patients receiving first-line chemotherapy. Methods: VEGF-A, VEGF-C, FLT1, KDR and FLT4 genotyping was performed on gastric tumours from 94 consecutive patients receiving platinum-based first-line chemotherapy. Results: Only theVEGF A rs25648 correlated with RR (PR = 18% among patients showing the VEGF A rs25648 CT or TT genotype vs. 44% among patients showing the VEGF A rs25648 CC genotype, p = 0.04). The VEGF A (rs2010963) and VEGF C (rs4604600 and rs7664413) correlated with mPFS and the VEGF A rs25648 and FLT4 rs307833 correlated with both mPFS and OS. Among other clinical variables tested (sex, age, ECOG performance status, gastrectomy, adjuvant chemotherapy, metastatic sites and second-line chemotherapy) only the use of second-line chemotherapy correlated with improved overall survival (10.2 months vs. 6.3 months for patients who received or did not receive second-line, p= 0.003). At multivariate the VEGF A rs25648 maintained an independent role in determining both median PFS (HR = 1.65 95% CI: 1.12-2.78, p= < 0.0001) and OS (HR = 1.58, 95% CI: 1.17-2.65, p = 0.0003). The use of second-line chemotherapy also showed an independent role in determining median OS (HR = 0.58, 95% CI: 0.38-0.87, p= 0.003). Conclusions: VEGF A rs25648 genotyping may help identifying a patients subgroup unlikely to benefit from a first-line, platinum-based combination and potentially candidate to alternative therapy choices. Our data may help designing future clinical trials with the aim to investigate the outcome of different chemotherapy regimens in different patients groups prospectively stratified according to angiogenesis profile.

scholarly journals P-0062 Second-Line Chemotherapy for Patients with Metastatic Gastric Cancer: a Retrospective Analysis

2012 ◽  
Vol 23 ◽  
pp. iv49
Author(s):  
Maria resa Te Alexandre ◽  
Ana Carla Luís ◽  
Ana Clara ◽  
Vasco Fonseca ◽  
João Freire ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Retrospective Analysis ◽  
Metastatic Gastric Cancer ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Line Chemotherapy

Prognostic factors in metastatic gastric cancer patients (pts) treated with second-line chemotherapy

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 15169-15169
Author(s):  
V. Catalano ◽  
F. Graziano ◽  
D. Santini ◽  
A. M. Baldelli ◽  
P. Giordani ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Weight Loss ◽  
Prognostic Factors ◽  
Performance Status ◽  
Second Line ◽  
First Line ◽  
Second Line Chemotherapy ◽  
Metastatic Sites ◽  
Ecog Ps ◽  
Line Chemotherapy

15169 Background: Currently, there is no established second-line chemotherapy for pts with advanced gastric cancer who failed to respond or progressed after a first-line chemotherapy. Many of these pts still have a good performance status or have symptoms to be palliated at the time of first-line failure and are candidates for second-line chemotherapy. However, phase II trials demonstrate divergent results about pts more likely to benefit from second-line chemotherapy. We retrospectively analyzed the influence of various clinicopathologic factors on the survival of pts treated with second-line chemotherapy. Methods: Analysis is based on the data of 169 pts consecutively treated at 3 oncology department with a second-line chemotherapy. Univariate and multivariate analyses were performed to determine prognostic factors of survival. The variable used for analysis were: sex, age, ECOG performance status, a weight loss > 5 Kg in the last month; site of primary tumor, histopathology; hemoglobin, serum albumin, and CEA levels, number and site of metastatic disease, response to and time-to-progression (TTP) with the first- line chemotherapy. Results: The variables predictive of better survival were: ECOG PS 0–1 (p<0.001), no weight loss (p=0.001), hemoglobin level > 10 g/dl (p=0.01), CEA level <50 U/ml (p<0.02), number of metastatic sites = 2 (p=0.002), TTP of the first-line chemotherapy > 4 months (p=0.008). Peritoneal carcinomatosis was predictive of poor survival only when associated with one or more signs or symptoms as vomiting, anorexia, abdominal pain, ascites(p=0.03). Four factors were independently associated with better overall survival: ECOG PS 0–1 (p=0.002; HR 0.46; CI 95%, 0.29–0.75), CEA level <50 U/ml (p=0.008; HR 0.54; CI 95%, 0.35–0.85), one or two metastatic sites of disease (p=0.01; HR 0.58; CI 95%, 0.39–0.88), and TTP of the first-line chemotherapy > 4 months (p=0.02; HR 0.66; CI 95%, 0.45–0.95). Conclusions: In the absence of data deriving from randomized, controlled, clinical trials, this analysis suggests that some clinical factors may help clinicians to better select groups of pts with gastric cancer more likely to benefit from a second-line chemotherapy. No significant financial relationships to disclose.

Prognostic factor analysis in third-line chemotherapy for elderly patients with metastatic gastric cancer.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 82-82 ◽  
Author(s):  
Hiroko Hasegawa ◽  
Tetsuya Iwasaki ◽  
Akio Ishihara ◽  
Yuko Sakakibara ◽  
Tomohumi Akasaka ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastric Cancer ◽  
Overall Survival ◽  
Elderly Patients ◽  
Metastatic Gastric Cancer ◽  
Salvage Treatment ◽  
Second Line ◽  
Clinicopathologic Factors ◽  
Third Line ◽  
Line Chemotherapy

82 Background: Recently, the proportion of elderly patients (pts) with metastatic gastric cancer (mGC) has increased in Japan. Survival benefits of salvage treatment after second-line chemotherapy (CTX) for mGC were shown in several prospective studies. However, the role of salvage treatment in elderly pts remains controversial. Methods: We reviewed 185 pts with mGC who received palliative CTX aged ≥ 70 years at our institution between April 2007 and March 2018. Eligibility criteria were as follows: PS 0-2, refractory to first-line and second-line CTX. The purpose of this study was to evaluate the clinicopathologic factors that affected overall survival for elderly pts with mGC, univariate and multivariate analyses were performed on the baseline factors at the beginning of third-line CTX. Results: Of all, 71 pts were eligible. Median age was 75 years (71-85). Median progression-free survival (PFS) and overall survival (OS) for third-line CTX were 3.2 and 7.5 months, respectively and an overall response rate and disease control rate were 4.2% and 43.7%, respectively. In univariate analysis, the following four factors were identified to have prognostic significance: performance status (PS) (ECOG 0–1 or 2), serum albumin level (< 3.5 or ≥ 3.5 g/dl), serum LDH level (≤ 240 or > 240 IU/l), PFS under second-line CTX (< 3 or ≥ 3 months). Multivariate analysis found three prognostic factors affecting poor survival following third-line CTX: PS of 2 (hazard ratio (HR) 8.89, 95% confidence interval (CI) 3.99–20.2; P = 0.001), serum LDH level > 240 IU/l (HR 2.75, 95% CI 1.48–5.05; P = 0.002) and median PFS under second-line CTX of < 3 months (HR 1.89, 95% CI 1.01–3.43; P = 0.045). A prognostic index was constructed, dividing pts into low- (0 factor), intermediate- (1-2 risk factors), or high- (3 risk factors) risk groups. Median OS for each group were 12.6, 6.0 and 3.0 months, respectively ( P < 0.001). Conclusions: This analysis suggests that some clinicopathologic factors might be helpful in identifying the subgroup of elderly pts most likely to benefit from third-line CTX for metastatic gastric cancer.

Geographic difference in safety and efficacy of systemic chemotherapy for advanced gastric or gastroesophageal carcinoma: A meta-regression approach.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 109-109 ◽  
Author(s):  
C. Hsu ◽  
Y. Shen ◽  
C. Cheng ◽  
A. Cheng ◽  
F. Hu ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Lower Incidence ◽  
Systemic Chemotherapy ◽  
Meta Analysis ◽  
Metastatic Gastric Cancer ◽  
Second Line ◽  
Second Line Chemotherapy ◽  
Meta Regression ◽  
Grade 3 ◽  
Line Chemotherapy

109 Background: The standard of chemotherapy regimens for patients with advanced or metastatic gastric cancer vary and the clinical outcome were heterogeneous in Asian vs. non-Asian countries. Methods: Treatment group-based meta-analysis and meta-regression were performed to analyze results of randomized trials published since 2005 for advanced or metastatic gastric cancer patients who received systemic chemotherapy as first-line treatment. Data were extracted and synthesized according to the Cochrane guidelines. Results: Among the 24 trials (totally 6,502 patients) eligible for meta-analysis, Asian trials reported lower percentage of gastroesophageal junctional carcinoma, higher percentage of diffuse-type histology, and more frequent use of second-line chemotherapy. Meta- regression analyses indicate that, after controlling other patient or treatment factors, Asian trials are associated with 22.7% (95% CI: 19.5-26.0%, p<0.0001) lower incidence of grade 3-4 neutropenia and 3.5% (95% CI: 2.1-4.9%, p<0.0001) lower incidence of grade 3-4 diarrhea, which were the most commonly reported toxicity. The use of high-dose infusional 5-fluorouracil, compared with other fuoropyrimidine regimens, reported 16.6% lower incidence of neutropenia (95% CI: 13.3-19.9%, p<0.0001). Higher percentage of patients with gastroesophageal junction carcinoma and patients with 2 or more organs involved predicted poor progression-free survival. The use of second-line chemotherapy predicts better 1-year overall survival, which will increase by 9% (95% CI: 8-10%) for every 10 percent increase in patients who received second-line chemotherapy. Conclusions: Geographic region (Asian vs. non-Asian) plays an important role in the heterogeneity of gastric cancer clinical trials and is an independent predictor of safety in systemic therapy for gastric cancer. No significant financial relationships to disclose.

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