P-0064 - Feasibility of irinotecan based chemotherapy as salvage regimen in elderly patients with metastatic or recurrent gastric cancer

Date 28 June 2014
Event World GI 2014
Session Poster Session
Topics Anti-Cancer Agents & Biologic Therapy
Gastric Cancer
Geriatric Oncology
Presenter Kyu-Hyoung Lim
Citation Annals of Oncology (2014) 25 (suppl_2): ii14-ii104. 10.1093/annonc/mdu165
Authors K. Lim, H. Lee, B. Park Sung, S. Song
  • Kangwon National University Hospital, Chuncheon-si/KR

Abstract

Introduction

The combination chemotherapy of 5-fluorouracil (5-FU) and platinum is usually used as first-line treatment in advanced gastric cancer (AGC). After failure of first line chemotherapy, the safety and efficacy of salvage chemotherapy in elderly patients with AGC has not been established yet. The purpose of this study was to assess the clinical feasibility of irinotecan based chemotherapy as salvage treatment in elderly patients with AGC and to evaluate the prognostic factors.

Methods

Eligibility included: 1) aged 60 or older, 2) histologically confirmed adenocarcinoma, 3) failure of platinum based chemotherapy or chemotherapy naive, 4) advanced disease with Stage IV or recurrence, 5) Eastern Cooperative Oncology Group (ECOG) performance status (PS) 0-2. Patients received irinotecan alone or combination of irinotecan, leucovorin and 5-FU. Response evaluation was done every 8 weeks with RECIST criteria and toxicity was evaluated with NCI-CTCAE.

Results

Between Aug 2007 and Aug 2013, 24 patients were enrolled. Median age was 69.7 years (range: 60.2–78.4), and there were 19 men (79.2%). 20 patients (83.3%) had ECOG PS 0-1 and 4 patients (16.7%) had PS 2. A median of five cycles (range 1-12) was administered. Best responses were partial response in 13 patients and stable disease in 4. Overall response rate was 54.2% (95% CI: 0.35-0.72). The median progression-free survival (PFS) and overall survival (OS) were 4.0 months (95% CI: 3.5-4.5) and 5.1 months (95% CI: 3.3-6.9), respectively. 12-month OS rate was 16.7%. Toxicity was relatively tolerable. Grade 3/4 hematologic toxicities were neutropenia (20.8%), anemia (16.7%) and thrombocytopenia (8.4%). The most common non-hematologic toxicity is grade 1/2 anorexia (70.8%). There was treatment-related death in one patient. ECOG PS was a significant prognostic factor for PFS (p < 0.001) and OS (p < 0.001).

Conclusion

The irinotecan based regimen is an active and feasible treatment option for elderly patients with AGC. EOCG PS is an important prognostic factor and deserves to be considered for the selection of suitable patients, especially in elderly patients.