Combination versus single-agent as palliative chemotherapy for gastric cancer

Abstract

Background: Although combination chemotherapy (CC) is generally recommended in recurrent or primary metastatic gastric cancer (RPMGC), the results of randomized trials are conflicting. Methods: A retrospective review was conducted on 687 RPMGC patients who received palliative chemotherapy. We compared the overall survival (OS) between CC and single-agent chemotherapy (SC) among these patients, and we analyzed the clinicopathological characteristics affecting outcome including neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Results: Although 521 patients (75.8%) underwent CC, SC was more frequently performed in elderly patients (57.6%) and ECOG performance status (PS) 2 or 3 (65.8%) patients (p < 0.0001, in each case). The median OS of patients who received CC was significantly longer than that of patients who received SC (11 vs. 8 months, p < 0.0001). No difference in OS between CC and SC was observed in elderly patients (p = 0.583), poor PS (p = 0.810), signet ring cell (p = 0.347), palliative surgical resection (p = 0.307), and high PLR (p = 0.120), with a significant interaction between age and type of regimen (p = 0.012). Moreover, there was no difference in OS between CC and SC after propensity score matching (p = 0.322). Multivariate analysis revealed that palliative resection and ≥ second-line chemotherapy were independently associated with favorable OS (p < 0.0001, in each case), whereas poor PS (p = 0.004), signet ring cell (p < 0.0001), peritoneal metastasis (p = 0.04), high NLR (p = 0.001), and high PLR (p = 0.033) were independent prognostic factors of poor OS. Conclusions: Although CC is the standard of care in RPMGC, SC can be considered a reasonable option in certain subgroups, such as elderly patients.

NF-κB in Gastric Cancer Development and Therapy

“…Despite advances in surgical techniques and the development of a combination of chemotherapy, radiotherapy, and molecular-targeted treatment, the survival rate of patients with GC remains unsatisfactory [ 11 , 12 , 13 , 14 , 15 ]. GC without metastasis can be potentially cured with surgery; however, most patients have an advanced inoperable stage or have recurrent disease after resection.…”

A New Hybrid δ-Lactone Induces Apoptosis and Potentiates Anticancer Activity of Taxol in HL-60 Human Leukemia Cells

“…In the 1970s it was demonstrated that in case of acute lymphocytic leukemia [46] and Hodgkin's lymphoma [47] combination chemotherapy could be more effective than using a single drug or two drugs one at a time, in sequence. While single-drug chemotherapy may still be better for some cancers, in the last decade combination of chemotherapy medications has been adopted for the treatment of many cancer types and has greatly increased survival rates [48][49][50]. The benefits of using combination chemotherapy rather than single agents include decreased occurrence of resistance and sometimes (but not always) reduced intensity of side effects due to the lower doses of two drugs instead of a high dose of one drug.…”

Trastuzumab-based palliative chemotherapy for HER2-positive gastric cancer: a single-center real-world data

“…Informed consent was waived by the IRB because this study was conducted using medical records of anonymized patients. Some patients (n = 9) in this study cohort were included in previous studies about palliative chemotherapy for RPMGC [4,14,15]. However, the follow-up of the patients was extended in the current study.…”