Oops, you're using an old version of your browser so some of the features on this page may not be displaying properly.

MINIMAL Requirements: Google Chrome 24+Mozilla Firefox 20+Internet Explorer 11Opera 15–18Apple Safari 7SeaMonkey 2.15-2.23

Poster display session

3969 - Comparison of cytotoxic backbones for first line trastuzumab-containing regimens in HER2-positive advanced esophagogastric cancer: A meta-analysis.

Date

09 Sep 2017

Session

Poster display session

Topics

Cytotoxic Therapy;  Oesophageal Cancer;  Gastric Cancer

Presenters

Emil ter Veer

Citation

Annals of Oncology (2017) 28 (suppl_5): v209-v268. 10.1093/annonc/mdx369

Authors

E. ter Veer1, A. Creemers2, L. de Waal2, M.G.H. van Oijen2, H.W.M. van Laarhoven2

Author affiliations

  • 1 Department Of Medical Oncology, Academic Medical Center (AMC), 1105AZ - Amsterdam/NL
  • 2 Department Of Medical Oncology, Academic Medical Centre, University of Amsterdam, Amsterdam/NL
More

Resources

Abstract 3969

Background

According to the ToGA study, trastuzumab plus cisplatin and capecitabine/5-fluorouracil (5-FU) is standard first-line treatment for HER2+ advanced esophagogastric cancer. However, optimality of this cytotoxic backbone is questioned. We examined the relative efficacy and safety of alternative trastuzumab-based cytotoxic backbone regimens compared to standard ToGA using meta-analysis.

Methods

Medline, EMBASE, CENTRAL and ASCO and ESMO were searched up to March 2017 for studies investigating alternative first-line trastuzumab-based regimens for patients with HER2+ esophagogastric cancer, with protein expression IHC3+ or IHC2+ and gene amplification by in situ hybridisation (ISH+). We compared overall survival (OS) of alternative trastuzumab-based regimens to trastuzumab plus cisplatin and capecitabine/5-FU of the ToGA trial IHC3+ or IHC2+/ISH+ subgroup. Hazard ratios (HR) and 95% confidence intervals (95%CI) were calculated by extraction of published Kaplan-Meier curves. Incidence counts and toxicity sample sizes were extracted for grade 1-2 and grade 3-4 adverse events and compared using single arm proportion meta-analysis.

Results

We included 15 studies (557 patients). For doublet backbone regimens, OS was significantly longer with trastuzumab plus oxaliplatin and capecitabine/5-FU compared to the ToGA regimen (median OS 20.7 vs 16.0 months, HR 0.75, 95%CI 0.59-0.99) and showed a more convenient toxicity profile. The doublet backbone trastuzumab plus cisplatin and S-1 showed no significant difference in OS compared to the ToGA regimen, but had a different toxicity profile, including less grade 1-2 hand-foot syndrome. Trastuzumab plus singlet backbone cisplatin or capecitabine had a significantly worse survival compared to the ToGA regimen and were more toxic. Trastuzumab with triplet cytotoxic backbones or with bevacizumab and doublet cytotoxic backbone had no survival benefit and were generally more toxic compared to ToGA.

Conclusions

Trastuzumab plus a doublet cytotoxic backbone containing oxaliplatin is preferable compared to the conventional ToGA regimen with cisplatin. S-1 can substitute capecitabine or 5-FU when specific toxicities are encountered.

Clinical trial identification

Not applicable

Legal entity responsible for the study

N/A

Funding

None

Disclosure

M.G.H. van Oijen: Unrestricted research grants from Bayer, Lilly, Merck Serono, and Roche. H.W.M. van Laarhoven: Consultant for Celgene, Lilly, and Nordic. Unrestricted research funding from Bayer, BMS, Celgene, Lilly, Merck Serono, MSD, Nordic, and Roche. All other authors have declared no conflicts of interest.

This site uses cookies. Some of these cookies are essential, while others help us improve your experience by providing insights into how the site is being used.

For more detailed information on the cookies we use, please check our Privacy Policy.

Customise settings
  • Necessary cookies enable core functionality. The website cannot function properly without these cookies, and you can only disable them by changing your browser preferences.