Maintenance Therapy in First-Line Gastric and Gastroesophageal Junction Adenocarcinoma: A Retrospective Analysis

Abstract

BackgroundFluoropyrimidine with platinum-based chemotherapy has become the standard of care for advanced gastric and gastroesophageal (GEJ) cancer. Trials in colon cancer show that induction chemotherapy followed by maintenance chemotherapy is an efficacious strategy to maximize clinical response while minimizing toxicity. The current retrospective study aims to evaluate the efficacy and tolerability of maintenance versus continuous treatment in advanced GEJ malignancy.MethodsA retrospective analysis of patients with metastatic gastric/GEJ adenocarcinoma treated with fluoropyrimidine and platinum chemotherapy between 2007-2017 was performed. Patients who achieved at least stable disease after initial induction treatment were included. After 16 weeks of induction chemotherapy, patients were categorized into the continuous group if induction chemotherapy was continued and the maintenance group if chemotherapy was switched to maintenance fluoropyrimidine monotherapy or observed off treatment. Endpoints were progression-free survival (PFS), overall survival (OS), and toxicities.ResultsIn total, 90 patients met the criteria, 48 received continuous therapy, and 42 received maintenance. Baseline characteristics were comparable. No difference in PFS (9.9 vs 8.4 months p = .28) or in OS (16.1 vs 21.3 months p = .75) was observed, including after controlling for the best response on induction therapy and other variables. In patients on continuous induction therapy, there was a higher prevalence of grade three neuropathy (42.6% vs 9.8% p = .001) and neutropenic fever (13% vs 0% p =.03).ConclusionsMaintenance therapy following induction fluoropyrimidine and platinum-based therapy is associated with an improved toxicity profile and appears to have comparable efficacy to continuous treatment in metastatic gastric/GEJ cancer.

Primary thromboprophylaxis in not surgically treated intra-luminal gastrointestinal cancer (ILGC) treated with first-line chemotherapy: A single institution preliminary safety report

“…Fluoropyrimidine and platinum-containing treatment is standard-of-care first - line chemotherapy for advanced gastric, gastroesophageal junction (GEJ) and colon cancer. 8 – 10 Response to treatment usually leads to a reduction in the extension of the neoplasm also in the intestinal lumen and as a results to a reduction in the risk of bleeding either spontaneously or induced by any anticoagulant treatment. DOACs often meet both patient’s and physician’s preference when antithrombotic therapy is required because there is no need of daily subcutaneous injection.…”

HNF4A-BAP31-VDAC1 axis synchronously regulates cell proliferation and ferroptosis in gastric cancer

“…Examining the potentials of ferroptosis in cancer therapy is a fast-growing field of study, where several ferroptosis inducers have been found to be beneficial and promising in pre-clinical studies [ 19 ]. Currently, fluoropyrimidine with platinum-based chemotherapy serve as the standard regimen in advanced GC, in which drug resistance occurs frequently [ 20 ]. Cancer cells exhibit an increased iron demand compared with normal cells, and the iron dependency can make cancer cells more vulnerable to ferroptosis and creates the potential of ferroptosis to be a new promising way to kill therapy-resistant cancers [ 21 ].…”