PD-0020 - Analysing the outcome and prognostic factors of elderly patients treated with single agent versus combination regimen as first-line chemotherapy for...

Date 27 June 2014
Event World GI 2014
Session Poster discussion session IV - Miscellaneous
Topics Anti-Cancer Agents & Biologic Therapy
Gastric Cancer
Geriatric Oncology
Presenter D.S. Sun
Citation Annals of Oncology (2014) 25 (suppl_2): ii5-ii13. 10.1093/annonc/mdu164
Authors D.S. Sun1, E.K. Jeon2, Y.H. Ko3, H.S. Won3, B.Y. Shim4, S.Y. Rho5, H.K. Kim4, S.Y. Park6, S.Y. Hong5
  • 1Uijeoungbu St. Mary's Hospital, The Catholic University of Korea, Uijeoungbu City/KR
  • 2Seoul St. Mary's Hospital, The Catholic University of Korea, Uijeongbu- si/KR
  • 3Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu-si/KR
  • 4St. Vincent's Hospital, Suwon/KR
  • 5Seoul St. Mary's Hospital, Seoul/KR
  • 6Daejeon St. Mary's Hospital, Daejeon/KR

Abstract

Introduction

Gastric cancer (GC) is one of the most common cancers and second leading cause of death in Korean elderly cancer patients. More than half of GC patients diagnosed with inoperable stage, and palliative chemotherapy would be the option of treatment in elderly GC patients for gaining survival time. We analysed the differences between single and combination first line palliative chemotherapy in elderly GC patients.

Methods

More than 70-year-old GC patients treated in the four centers of the Catholic university of Korea were analyzed. Baseline characteristics including performance status (PS), comorbidity, TNM stage as prognostic factors were analysed, first line chemotherapy regimen, treatment responses, toxicities, progression free survival (PFS) 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 combination regimen. The median age was 77 years (range 70-89) in single regimen group (SG, 70 patients) and 73 years (range 70-81) in combination group (CG, 108 patients). TS-1 or capecitabine was used in SG, and platinum combined with 5FU or taxane was the most common regimen in CG. The most common response in both groups was stable disease (SG 45.7%, CG 48.1%). Median relative dose intensity was 92.4% (range 50 ∼ 100%) in SG and 83.5% (range 43 ∼ 100%) in CG. Median PFS in SG was 4.40 months (95% CI, 2.85-5.95) and 4.10 months in CG (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 CG. The univariate analysis demonstrated that three clinical factors were significantly associated with a shorter OS; these factors including T stage, N stage, and number of metastasized regions. In the multivariate regression analysis using the Cox proportional hazards regression model, the N stage (HR 2.990, 95% CI 1.191-7.501; P = 0.02) was the only one identified independent prognostic factor that associated with OS, while the type of chemotherapy was not significant (HR 0.987, 95% CI, 0.645-1.509, P = 0.951). Hematologic (P = 0.03) and non-hematologic toxicities (P = 0.061) were more frequent in CG. The common causes to terminate chemotherapy were disease progression in SG and decreased performance status in CG.

Conclusion

No significant differences were observed in PFS and OS in both groups, but treatment related hematologic toxicity of SG was less than CG. Single agent treatment would be considered as the option of first line palliative chemotherapy in the elderly more than 70 years.