Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry

Abstract

Background Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry.

Heterogeneity of first‐line palliative systemic treatment in synchronous metastatic esophagogastric cancer patients: A real‐world evidence study

“…The use of an unusual treatment regimen may limit opportunities for second-line treatment and subsequent OS benefit. [4][5][6]14 In our study, we found less serious (grade 3-5) toxicity in patients receiving doublets (21%) compared to triplets (33%) as well as similar OS and TTF rates, which supports the shift toward doublet therapy as preferred strategy in these patients. Current national and international guidelines recommend a fluoropyrimidine and platinum doublet in metastatic esophagogastric cancer patients, with the addition of an anthracycline or taxane in selected patients.…”

“…25,26 Since the added value of the addition of an anthracycline to a platinum-fluoropyrimidine doublet remains uncertain, 15,[27][28][29] doublet chemotherapy tends to be the favored choice of firstline palliative treatment because of its better tolerance. [4][5][6]14 In our study, we found less serious (grade 3-5) toxicity in patients receiving doublets (21%) compared to triplets (33%) as well as similar OS and TTF rates, which supports the shift toward doublet therapy as preferred strategy in these patients.…”

“…[3][4][5][6] However, the optimal first-line palliative systemic therapy regimen for metastatic esophagogastric cancer patients has not yet been identified. 6,14,15 Because of the lack of consensus on optimal palliative systemic treatment, making choices about the best approach for these patients is challenging, which can result in interhospital and interphysician variation in individual systemic treatment. [7][8][9][10][11] Triplet therapy, in which either an anthracycline or taxane is added to the platinum-fluoropyrimidine doublet, is suggested in international guidelines for patients in good condition, 8,10,12,13 but becomes increasingly controversial because of its toxicity.…”

“…[7][8][9][10][11] Triplet therapy, in which either an anthracycline or taxane is added to the platinum-fluoropyrimidine doublet, is suggested in international guidelines for patients in good condition, 8,10,12,13 but becomes increasingly controversial because of its toxicity. 6,14,15 Because of the lack of consensus on optimal palliative systemic treatment, making choices about the best approach for these patients is challenging, which can result in interhospital and interphysician variation in individual systemic treatment. This could eventually affect survival and quality of life, and might be the explanation for stagnating survival rates, despite an increase in the administration of palliative systemic therapy from <10% to 40% of metastatic esophagogastric cancer patients between 1990 and 2011 in the Netherlands.…”

Efficacy and safety of chemotherapy in older versus non-older patients with advanced gastric cancer: A real-world data, non-inferiority analysis

“…Patients are from the AGAMENON database, a national registry of consecutive cases of AGC, in which 30 Spanish centers and one Chilean center have participated. The study design, characteristics, method, and data quality criteria have been widely communicated elsewhere (9)(10)(11)(12)(13).AGAMENON is a non-interventionist database sponsored by the investigators themselves. Data are collected by means of a web-based data collection tool (http://www.agamenonstudy.com/).…”