Background Individuals with advanced gastric cancer (AGC) who present with severe peritoneal metastasis (SPM) have poor prognosis, and the need to improve treatment for such condition and survival time is not met. Moreover, there are only few data about the second-line treatment for patients with such condition. Methods This retrospective study included patients receiving taxane-based second-line chemotherapy at three institutions in Japan between 2010 and 2016. Patients with AGC who present with SPM were included if they had massive ascites and/or inadequate oral intake requiring intravenous nutritional support. The efficacy and safety of the treatment were evaluated. Results In the present study, 43 (40%) of 108 patients had an Eastern Cooperative Oncology Group Performance Status score > 2, and the median serum albumin level of the patients was 3.3 g/mL. Ramucirumab was used in combination with paclitaxel in 21 patients. The median overall survival (OS) and progression-free survival (PFS) were 5.1 and 2.8 months, respectively. Inadequate oral intake was considered a negative prognostic factor of both OS and PFS in the multivariate analysis. Three treatment-related deaths were observed, which include those attributed to febrile neutropenia, gastrointestinal perforation, and pneumonitis. Common grade > 3 adverse events were neutropenia (35%), leukopenia (30%), anemia (24%), and anorexia (16%). We observed febrile neutropenia in 8% and gastrointestinal perforation in 4% of patients, and such conditions were primarily observed in patients with inadequate oral intake. Conclusions Taxane-based second-line chemotherapy was effective and safe for patients with AGC who present with SPM. Attention must be provided when treating patients with inadequate oral intake as they are likely to have short prognosis and serious toxicities.

Background:Geriatric 8 (G8) is a useful screening tool for geriatric assessment for predicting survival or risk of serious adverse events (SAEs) in older cancer patients. However, the clinical utility of G8 is not well known in older patients with gastrointestinal (GI) cancer developing malnutrition. We investigated the association between G8 score and clinical outcomes in older patients with GI cancer.Methods: We retrospectively registered patients with GI cancer aged ≥65 years who received a G8 questionnaire at first visit from April 2018 to March 2020. The G8 score, SAE, dose reduction rate, discontinuation rate, and overall survival (OS) were evaluated. Safety was assessed in all patients and OS in GI cancer patients with unresectable tumors.Results:In a total of 207 patients (median age: 75, range: 65–92, 56% of unresectable cancer), the median G8 score was 10.5 and the percentage of normal G8 score was only 6.8%. There was no clear association between G8 score and OS or SAEs in 143 (69%) patients received chemotherapy (CT). However, the median G8 score was significantly higher in patients with CT compared to those without CT (11.5 vs 10.0 months, p < 0.0001). One-hundred seven of 129 (83%) older patients with abnormal G8 score were treated with CT by treatment modification such as dose reduction, and they had no unexpected SAEs and better prognosis than those without CT. The rate of normal instrumental activity of daily life (IADL) was significantly higher in patients with CT compared to those without CT (64% vs. 23%, p < 0.0001). In addition, there was a significant difference in OS according to IADL even in patients with abnormal G8 score.Conclusions:There was no association between G8 score and OS or SAE in older patients with GI cancer; however, most patients with abnormal G8 score could receive CT safely and effectively through treatment modification. The IADL may be clinically useful to predict prognosis and determine the treatment plan for older patients.