Chemotherapy treatment patterns and neutropenia management in gastric cancer

Abstract

Background Potentially myelosuppressive doublet and triplet chemotherapy combination regimens are considered the most active treatments in gastric cancer. This multicenter prospective observational study was designed to gain insight into the chemotherapy regimens being used in Europe and to evaluate neutropenia management in patients identified as at high risk for febrile neutropenia (FN). Methods Eligible patients had gastric cancer, were scheduled for C 3 cycles of myelosuppressive chemotherapy, and had an investigator-assessed overall FN risk C 20 %. Data were collected for up to ten cycles. The primary endpoint was the proportion of patients who received granulocyte colony stimulating factor (G-CSF) primary prophylaxis (defined as G-CSF initiated on days 1-7 of cycle 1). Secondary endpoints included FN incidence, chemotherapy administration, and G-CSF use. Results Of 199 patients who met the eligibility criteria and started at least one cycle of chemotherapy, mean age was 63 years, 76 % were men, 83 % had an ECOG score of 0 or 1, 54 % had metastatic disease, and 24 % had received prior chemotherapy. A total of 27 different backbone regimens were given; the most common regimen was modified docetaxel, cisplatin, and 5-fluorouracil (DCF). Despite all patients having been identified as having a C 20 % FN risk, only 70 (35 %) received G-CSF primary prophylaxis. FN occurred in 14 patients overall (7 %). Most FN events occurred in patients who received DCF/modified DCF (9/14 events, 64 %). Conclusions The results of this study reveal a high use of myelotoxic treatment regimens in gastric cancer in Europe and low adherence to clinical practice guidelines for the use of primary and secondary G-CSF prophylaxis for FN.

Treatment Patterns, Costs, and Survival among Medicare-Enrolled Elderly Patients Diagnosed with Advanced Stage Gastric Cancer: Analysis of a Linked Population-Based Cancer Registry and Administrative Claims Database

“…The available data are dated and/or limited in terms of evaluating all aspects of direct costs. 31 32 33 34 35 Thus, we believe the current study provides more comprehensive and complete direct utilization and cost data. These data more accurately reflect the cost of treating this population, and thus, they may help better inform future cost-effectiveness analyses for newer treatments.…”

Czynniki pobudzające granulopoezę są nadużywane w systemowym leczeniu onkologicznym

“…Prospektywne badanie obserwacyjne profilaktyki pierwotnej u 199 chorych na raka żołądka otrzymujących chemioterapię związaną z ryzykiem GN ≥ 20% wykazało, że tylko 35% chorych otrzymało G-CSF zgodnie z zaleceniami, ale GN wystąpiła zaledwie w 7% przypadków [20]. Ponadto GN występowała częściej u chorych, którzy otrzymywali (10%), niż u tych, którzy -wbrew zaleceniom -nie otrzymywali G-CSF w pierwotnej profilaktyce (5%).…”

The Efficacy and Safety of Modified Docetaxel, Cisplatin, and 5-Fluorouracil Vs. Epirubicin, Oxaliplatin, and Capecitabine Regimen in the Advanced Gastric Cancer: A Randomized Controlled Clinical Trial

“…In first-line palliative three-drug chemotherapy, different regimens, with various drugs and doses, have been suggested. However, there is still a gap in knowledge, and none of the proposed agents have been approved as the gold standard of treatment for advanced gastric cancer; therefore, there is an urgent need to improve and correct these regimens (de Gramont et al, 1988;de Gramont et al, 1997;Özdemir et al, 2010;Shah et al, 2010;Unek et al, 2013;Kalinka-Warzocha et al, 2015). The modified docetaxel, cisplatin, and 5-fluorouracil (m-DCF) regimen is one of the most common regimens, which uses adjusted doses of docetaxel, cisplatin, and 5-fluorouracil, with the aim of reducing hematological and gastrointestinal toxicity caused by factor D (5-10).…”

“…The modified docetaxel, cisplatin, and 5-fluorouracil (m-DCF) regimen is one of the most common regimens, which uses adjusted doses of docetaxel, cisplatin, and 5-fluorouracil, with the aim of reducing hematological and gastrointestinal toxicity caused by factor D (5-10). The efficacy of m-DCF regimen has been approved in several clinical trials for advanced gastric cancer (de Gramont et al, 1988;de Gramont et al, 1997;Shah et al, 2010;Unek et al, 2013;Kalinka-Warzocha et al, 2015). Many researchers have used this regimen, alone or in combination with other chemotherapy agents, to treat advanced gastric cancer and confirmed its safety and efficacy (Unek et al, 2013).…”

“…Many researchers have used this regimen, alone or in combination with other chemotherapy agents, to treat advanced gastric cancer and confirmed its safety and efficacy (Unek et al, 2013). Despite the acceptable level of toxicity associated with this regimen, there are still uncertainties about its application, which indicate the need for future studies to evaluate different doses of DCF (de Gramont et al, 1997;Cunningham et al, 2008;Shah et al, 2010;Unek et al, 2013;Kalinka-Warzocha et al, 2015;Ochenduszko et al, 2015) Another regimen used in some oncologic centers as first-line treatment for gastric and gastroesophageal junction cancers is epirubicin, oxaliplatin, and capecitabine (EOX) regimen, which showed a significantly higher efficacy in REAL2 clinical trial, compared with the ECF regimen. In this trial, the survival rate was 11.2 months in EOX patients versus 9.9 months in ECF patients.…”