Second-line chemotherapy for patients with advanced gastric cancer: who may benefit?

Abstract

No established second-line chemotherapy is available for patients with advanced gastric cancer failing to respond or progressing to first-line chemotherapy. However, 20 -40% of these patients commonly receive second-line chemotherapy. We evaluated the influence of clinico-pathologic factors on the survival of 175 advanced gastric cancer patients, who received second-line chemotherapy at three oncology departments. Univariate and multivariate analyses found five factors which were independently associated with poor overall survival: performance status 2 (hazard ratio (HR), 1.79; 95% CI, 1.16 -2.77; P ¼ 0.008), haemoglobin p11.5 g l À1 (HR, 1.48; 95% CI, 1.06 -2.05; P ¼ 0.019), CEA level 450 ng ml À1 (HR, 1.86; 95% CI, 1.21 -2.88; P ¼ 0.004), the presence of greater than or equal to three metastatic sites of disease (HR, 1.72; 95% CI, 1.16 -2.53; P ¼ 0.006), and time-toprogression under first-line chemotherapy p6 months (HR, 1.97; 95% CI, 1.39 -2.80; Po0.0001). A prognostic index was constructed dividing patients into low-(no risk factor), intermediate-(one to two risk factors), or high-(three to five risk factors) risk groups, and median survival times for each group were 12.7 months, 7.1 months, and 3.3 months, respectively (Po0.001). In the absence of data deriving from randomised trials, this analysis suggests that some easily available clinical factors may help to select patients with advanced gastric cancer who could derive more benefit from second-line chemotherapy.

Irinotecan combined with 5-fluorouracil and leucovorin third-line chemotherapy after failure of fluoropyrimidine, platinum, and taxane in gastric cancer: treatment outcomes and a prognostic model to predict survival

“…2 Progression-free survival and overall survival curves according to the risk groups: a progression-free survival; b overall survival studies analyzed the prognostic factors for MRGC patients undergoing second-line chemotherapy. A good PS was the most important prognostic factor of second-line chemotherapy in nearly all studies [6,[23][24][25]; in addition, a higher hemoglobin level [23][24][25], longer PFS from firstline chemotherapy [6,23,25], and a lower number of metastatic sites [6,25] were reported as independent prognostic factors for OS. Shim et al [15] reported a prognostic factor analysis of third-line therapy; poor PS (ECOG PS C2), low serum albumin level (\4.0 g/dl), poor histological grade, and shorter PFS following second-line chemotherapy (\2.7 months) were factors related to poor survival outcome.…”

Clinical significance of serum tumor markers for gastric cancer: a systematic review of literature by the Task Force of the Japanese Gastric Cancer Association

“…Univariate and multivariate analyses showed that elevated CEA levels [50 ng/ml were significantly associated with poor overall survival. This analysis suggests that readily available clinical factors may help to select patients with advanced gastric cancer who may benefit from second-line chemotherapy [67].…”

Management of advanced gastric cancer

“…Patient selection is thus an important consideration, and several clinical factors have been associated with poor OS after secondline therapy [75]: low PS (two or more); hemoglobin ≤11.5 g/l; carcinoembryonic antigen level >50 ng/ml; the presence of three or more metastatic sites of disease; and TTP on first-line chemotherapy ≤6 months. Survival of AGC patients who received second-line chemotherapy was shown to be related to the number of adverse prognostic factors: median survival was 12.7 months (no risk factor), 7.1 months (one to two risk factors) and 3.3 months (three to five risk factors), respectively (p < 0.001).…”