657P - Second- and third-line chemotherapy in advanced gastric cancer: A real-life clinical picture

Date 29 September 2014
Event ESMO 2014
Session Poster Display session
Topics Anticancer Agents
Gastric Cancer
Biological Therapy
Presenter Mario Uccello
Citation Annals of Oncology (2014) 25 (suppl_4): iv210-iv253. 10.1093/annonc/mdu334
Authors M. Uccello1, S. Cordio1, M. Mattina1, D. Sambataro1, C. Martines1, P. Salice1, D. Centonze2, G. Giannone2, R. Bordonaro1
  • 1Medical Oncology, A.R.N.A.S. Garibaldi, 95122 - Catania/IT
  • 2Surgical Oncology, A.R.N.A.S. Garibaldi, 95122 - Catania/IT



Chemotherapy is the mainstay of palliative treatment for metastatic or unresectable gastric cancer. Nevertheless, almost all patients (pts) will develop progressive disease after 1st-line treatment. The role of subsequent salvage chemotherapy is not well established, especially outside of clinical trials.


We reviewed 223 pts with histologically proven unresectable or metastatic gastric and gastroesophageal junction adenocarcinoma who received 1st-line chemotherapy at our Institution between August 2004 and December 2013. At the time of progression, 105 (47%) pts received 2nd-line chemotherapy. The choice of 2nd-line schedule was primarily driven by performance status and progression free survival during 1st-line treatment (mPFS1). After 2nd-line failure, 37 pts underwent 3rd-line therapy. Data from medical records were retrospectively analyzed.


For 2nd-line treatment, median progression free survival (mPFS2), median overall survival (mOS) and response rate (RR) were 2.9 months (mo), 5.5 mo, and 17%, respectively. The table below summarizes efficacy data with the various schedules used. The mPFS and mOS from starting 3rd-line treatment were 2.4 mo and 5.4 mo, whereas the RR achieved was 6%. Discontinuation due to adverse events occurred in 3% of pts during 2nd-line and 8% of those given 3rd-line. No toxic deaths were registered during treatment. However, fifty percent of pts received 2nd-line chemotherapy with dose reduction ab initio.

Summary of 2nd-line efficacy data with the various schedules used
Schedule pts (n) RR n (%) mPFS1 (mo) mPFS2 (mo) mOS mo
Overall 105 17/101 (17) 7.3 2.9 5.5
Platinum-based 17 8/17 (47) 10.3 4.3 12.5
FOLFIRI 29 5/26 (19) 8.3 4.2 7.3
Taxane 43 3/42 (7) 6.2 2.5 4.1
Other 16 1/15 (7) 7.1 2.8 5.1


In line with the limited prospective data available, 2nd-line chemotherapy was safely administered to almost half of pts progressing under 1st-line and appeared to be moderately effective. Pts with longer mPFS1 were likely to receive platinum-based regimen or FOLFIRI as 2nd-line chemotherapy, obtaining interesting outcomes. After 2nd-line progression, only a small subgroup of pts continued to benefit from further treatment. Further investigations are strongly advocated to improve treatment outcomes in this setting.


All authors have declared no conflicts of interest.