First-line single-agent chemotherapy for patients with recurrent or metastatic gastric cancer with poor performance status

Gastric cancer is one of most common types of cancers. Metastatic gastric cancer has a poor prognosis and is accepted as incurable at this stage. Treatment of metastatic gastric cancer did not progress substantially until new targeted agents have come out. Recently published ToGA trial showed promising results in HER2 overexpressing metastatic gastric cancer. In this case we present a case with an excellent complete response with anti-HER2 treatment. Most importantly, we wanted to emphasize (1) the importance of early determination of HER2 overexpression, and (2) to draw attention of anti-HER2 agents in the first line treatment even in patients with a poor performance status.

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A Review of Docetaxel: Its Use in the Treatment of Gastric Cancer

Clinical Medicine Insights Therapeutics ◽

10.4137/cmt.s5191 ◽

2010 ◽

Vol 2 ◽

pp. CMT.S5191

Author(s):

Alessandro Inno ◽

Michele Basso ◽

Alessandra Cassano ◽

Carlo Barone

Keyword(s):

Gastric Cancer ◽

Phase Ii ◽

Performance Status ◽

Single Agent ◽

Progression Free Survival ◽

Poor Performance ◽

Phase Iii ◽

Poor Performance Status ◽

Phase Ii Studies ◽

Combination Regimens

Docetaxel, a member of the taxane family, promotes cell death by binding β-tubulin and has demonstrated activity against several human malignancies, both as a single agent and in combination therapy. It has been approved in Europe and the US as front-line treatment for advanced gastric cancer in combination with cisplatin and fluorouracil (DCF regimen). This approval was based on the results of a pivotal study (V325) which demonstrated that the addition of docetaxel to the reference regimen of cisplatin and fluorouracil improves overall survival and progression-free survival with a better quality of life despite increased toxicity (mainly haematological). Modifications of DCF regimen have been successfully investigated as a means of making the treatment more tolerable and suitable also for elderly patients or patients with poor performance status. Emerging data from several phase II studies suggest that other docetaxel-based combination regimens with anthracyclines or irinotecan have interesting activity with acceptable toxicity profiles, but the true efficacy of these regimens needs to be assessed in large randomized phase III studies. Thus, the best docetaxel-containing regimen has yet to be identified. Docetaxel also represents a good candidate for combination with novel molecular target agents. In light of the high response rates observed in phase II-III studies, a docetaxel-based chemotherapy regimen might also be considered a treatment option as perioperative or adjuvant therapy in potentially curable gastric cancer and further studies with or without biological agents are eagerly awaited in this setting.

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Analysis of a prospectively randomized comparison of doxorubicin versus 5-fluorouracil, doxorubicin, and BCNU in advanced gastric cancer: implications for future studies.

Journal of Clinical Oncology ◽

10.1200/jco.1986.4.9.1348 ◽

1986 ◽

Vol 4 (9) ◽

pp. 1348-1355 ◽

Cited By ~ 53

Author(s):

J A Levi ◽

R M Fox ◽

M H Tattersall ◽

R L Woods ◽

D Thomson ◽

...

Keyword(s):

Gastric Cancer ◽

Advanced Gastric Cancer ◽

Performance Status ◽

Single Agent ◽

Locally Advanced ◽

Poor Performance ◽

Poor Performance Status ◽

Measurable Disease ◽

Duration Of Response ◽

And Performance

A multi-institutional cooperative study of patients with locally advanced, recurrent, or metastatic gastric adenocarcinoma who had not previously received chemotherapy was conducted, prospectively randomizing patients to receive either doxorubicin or the three-drug combination, 5-fluorouracil (5-FU), doxorubicin (Adriamycin; Adria Laboratories, Columbus, Ohio), and BCNU (FAB). The 187 evaluable patients were initially stratified according to the presence of measurable or evaluable disease and performance status. There was a significantly higher response rate observed for FAB (40%) compared with doxorubicin (13%) among the 145 measurable-disease patients. Duration of response and survival were significantly longer for FAB in the measurable-disease group, but for the total patient population an early advantage for FAB in time to disease progression and survival was lost with continued follow-up. Median survival was 33 weeks for patients receiving FAB and 19 weeks for those receiving doxorubicin. Significant pretreatment factors adversely affecting survival included poor performance status, weight loss of greater than 10%, and more than two sites of metastases. Toxicity was not severe in either treatment arm, and only thrombocytopenia occurred significantly more often with FAB. It is contended that in the treatment of advanced gastric cancer, chemotherapy only exerts a relatively short-term and modest beneficial effect, most apparent in patients with intermediate tumor bulk. 5-FU remains the most active single agent, and combination chemotherapy has not yet proven its overall worth. Further studies are indicated comparing the most active combinations with 5-FU using optimal doses and schedules, and consideration must be given to the incorporation of no-treatment controls.

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Comparison of outcomes for the elderly patients treated with single agent versus doublet regimen as first-line chemotherapy for recurrent or metastatic gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2014.32.3_suppl.136 ◽

2014 ◽

Vol 32 (3_suppl) ◽

pp. 136-136

Author(s):

Der Sheng Sun ◽

Yoon Ho Ko ◽

Eun Kyoung Jeon ◽

Hye Sung Won ◽

Byoung Young Shim ◽

...

Keyword(s):

Gastric Cancer ◽

Palliative Chemotherapy ◽

Performance Status ◽

Single Agent ◽

Dose Intensity ◽

The Elderly ◽

Metastatic Gastric Cancer ◽

Hematologic Toxicity ◽

First Line ◽

Line Chemotherapy

136 Background: Gastric cancer (GC) is a second leading cause of death in Korean elderly cancer patients. Palliative chemotherapy would be an option of treatment in inoperable elderly GC patients for gaining survival time. We analysed the differences between single and doublet first line palliative chemotherapy in elderly GC patients. Methods: More than 70-year-old GC patients treated in the hospitals of the Catholic university of Korea were analysed. Baseline characteristics, first-line chemotherapy regimen, treatment responses, toxicities, time to progression (TTP) and overall survival (OS) were evaluated. Results: From 2005 to 2012, 178 GC patients above 70 years had been treated with palliative chemotherapy with single or doublet regimen. The median age were 77 years (range 70-89) in single regimen group (SG, 70 patients) and 73 years (range 70-81) in doublet regimen group (DG, 108 patients). TS-1 or capecitabine was used in SG, and platinum combined with 5FU or taxane was the most common regimen in DG. The most common response in both group was stable disease. Median relative dose intensity was 92.4% (range 50~100%) in SG and 83.5% (range 43~100%) in DG. Median TTP in SG was 4.40 months (95% CI, 2.85-5.95) and 4.10 months in DG (95% CI, 2.62-5.57, P=0.295). Median OS was 6.90 months (95% CI, 4.20-9.59) in SG, 8.20 months (95% CI, 5.96-10.43, p=0.918) in DG. Hematologic (P=0.03) and non-hematologic toxicities (p=0.061) were more frequent in DG. The common causes to terminate chemotherapy were disease progression in SG and decreased performance status in DG. Conclusions: No significant differences were observed in TTP and OS in both groups, but treatment related hematologic toxicity of SG was less than DG. Single agent treatment would be considered as the option of first line palliative chemotherapy in the elderly more than 70 years.

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Dramatic Response to First Line Single Agent Pembrolizumab in Anaplastic Thyroid Carcinoma

Case Reports in Endocrinology ◽

10.1155/2019/9095753 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Valérie Spalart ◽

Barbara Legius ◽

Kurt Segers ◽

Johan Coolen ◽

Brigitte Maes ◽

...

Keyword(s):

Thyroid Carcinoma ◽

Performance Status ◽

Single Agent ◽

Poor Performance ◽

Anaplastic Thyroid Carcinoma ◽

Poor Performance Status ◽

First Line ◽

Extracranial Disease ◽

Deadly Disease ◽

The Brain

Anaplastic thyroid carcinoma (ATC) is a deadly disease with very limited therapeutic options. There is an urgent need for new and efficacious drugs. Unfortunately accrual in clinical trials is problematic because of the rarity of the disease and often poor performance status at diagnosis. Recently some data have emerged suggesting a role for immunotherapy in the treatment of ATC. We describe the case of a 75-year-old patient with poor performance status and compromised airway and oesophagus at diagnosis, showing a rapid and dramatic response to first line single agent pembrolizumab. Disease progression in the brain occurred 16 months after initial diagnosis. At that time there was ongoing extracranial disease control.

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