First-line triplet or doublet chemotherapy for advanced gastric cancer: Analysis of 970 patients from a community practice registry

Date

08 Oct 2016

Session

Poster Display

Presenters

Isabel Echavarria Diaz-Guardamino

Citation

Annals of Oncology (2016) 27 (6): 207-242. 10.1093/annonc/mdw371

Authors

I. Echavarria Diaz-Guardamino1, A. Carmona-Bayonas2, P. Jimenez Fonseca3, A.J. Muñoz Martin1, M.L. Sanchez Lorenzo3, A. Custodio4, M. Garrido5, J.M. Cano6, J.E. Lorenzo Barreto7, A. Lacalle8, M. Ferrer Cardona9, M. Manga10, L. Visa11, E. Buxo12, A. Azkarate13, A. Diaz14, A. Ramchandani15, M. Mugica16, P. Sala17, P. García Alfonso1

Author affiliations

  • 1 Medical Oncology, Hospital General Universitario Gregorio Marañon, 28007 - Madrid/ES
  • 2 Hematology And Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia/ES
  • 3 Medical Oncology, Hospital Universitario Central de Asturias, Oviedo/ES
  • 4 Medical Oncology, Hospital Universitario La Paz, 28046 - Madrid/ES
  • 5 Hematology And Medical Oncology, Pontificia Universidad Catolica de Chile-Cancer centre, Santiago/CL
  • 6 Clinical Oncology, Hospital General Ciudad Real, 13005 - Ciudad Real/ES
  • 7 Medical Oncology, Hospital Universitario de Canarias, Santa Cruz/ES
  • 8 Medical Oncology, Complejo Hospitalario de Navarra, Pamplona/ES
  • 9 Medical Oncology, Hospital de Sabadell Corporacis Parc Tauli, Sabadell/ES
  • 10 Medical Oncology, Hospital Galdakao, Galdakao/ES
  • 11 Department Medical Oncology, University Hospital del Mar, 08003 - Barcelona/ES
  • 12 Medical Oncology, Hospital Clinic, Barcelona/ES
  • 13 Medical Oncology, Hospital Universitario Son Espases, Palma de Mallorca/ES
  • 14 Medical Oncology, University Hospital 12 De Octubre, Madrid/ES
  • 15 Medical Oncology, Hospital Universitario Insular de Gran Canaria, Las Palmas/ES
  • 16 Medical Oncology, Hospital Universitario Marques de Valdecilla, Santander/ES
  • 17 Medical Oncology, Clinica Universitaria de Navarra, Pamplona/ES
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Resources

Background

There is no consensus as to the optimal first-line chemotherapy for patients with advanced gastric cancer (AGC) and up to 10 polychemotherapy schemes can be considered appropriate in this setting. This study aims to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry.

Methods

The AGAMENON registry included patients with AGC treated with polychemotherapy without trastuzumab from 2008-2016. The effect of triplets vs. doublets was compared using three methods: Cox proportional hazards (PH) regression, Propensity Score Matching (PSM), and Coarsened Exact Matching (CEM).

Results

970 patients from 28 centers were recruited. Triplets were associated with better survival, with a hazard ratio (HR) 0.84 (95% confidence interval (CI), 0.72-0.98), p= 0.035. After adjusting for confounding factors (Cox model) and after PSM, a significant increase in survival, 11.14 (95% CI, 9.60-12.68) vs. 9.60 months (95% CI, 8.44-10.75) was seen in favor of triplets; HR 0.77 (95% CI, 0.65-0.92), stratified log-rank test, p = 0.004. The trend was similar after CEM with a HR 0.76 (95% CI, 0.61-0.94), p = 0.015. Higher response rates were seen with triplets than doublets: 49.6% vs. 39.2%. In the binary logistic regression, the variables associated with the use of triplets were: not having a chronic cardiopathy; good performance status (ECOG 0-1); age; unresectable, locally advanced tumors (compared to metastatic disease); extrahepatic metastases; diffuse tumors; tumors with signet ring cells; high baseline CEA (≥10 ng/dL), and no prior perioperative chemotherapy. Triplets had more severe toxicity (grade 3-4) in comparison with doublets, particularly more febrile neutropenia (10.4% vs. 6.5%), hepatic toxicity (15.8% vs. 9.2%), and toxicity-related hospitalization (30.7% vs. 22.6%).

Conclusions

Our study suggest that triplets might be associated with a discreet benefit in efficacy in AGC at the expense of a moderate increase in toxicity, although its observational design should be taken into account.

Legal entity responsible for the study

AGAMENON group. Hospital Universitario Central de Asturias

Funding

N/A

Disclosure

All authors have declared no conflicts of interest.

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