Treatment features of systemic chemotherapy in young adults with unresectable advanced or recurrent gastric cancer

Abstract

PurposeGastric cancer in young adults (GCYA) is known to have distinct clinicopathological features, including a female predominance and diffuse-type histology. Previous reports have focused on patients who had undergone gastrectomy with curative intent. Information concerning the treatment of unresectable advanced- or recurrent-stage GCYA is lacking. Therefore, we aimed to investigate whether the distinct clinicopathological features of GCYA affect the outcome of systemic chemotherapy.Patients and methodsWe conducted a retrospective cohort study at a single institution in Japan. GCYA was classified as a disease in individuals who were <40 years of age at diagnosis. Initial systemic chemotherapy regimens for GCYA were investigated with a focus on patients who received S-1 plus cisplatin (SP) as a representative standard regimen. The efficacy, safety, and feasibility of systemic chemotherapy were evaluated.ResultsEighty-nine (7.5%) of 1,184 consecutive patients who received systemic chemotherapy at our institute between December 2005 and June 2016 were enrolled. As reported previously, the female sex (57.3%) and diffuse-type histology (91.0%) were the dominant features of GCYA. Thirty-two patients (36.0%) received SP as first-line treatment. The median overall survival and progression-free survival times were 13.2 (95.0% CI: 9.5–18.7) and 5.6 (95.0% CI: 4.7–7.9) months, respectively. The median number of treatment cycles, relative dose intensity, and cumulative dose of cisplatin were 4.5 (range: 1–10), 92.0% (IQR: 83.5–98.3), and 286.5 mg/m2 (IQR: 172.5–367.5), respectively. The most common adverse event of Grade 3 or higher was neutropenia (n=5 patients; 15.6%). No patient had febrile neutropenia. Non-hematological adverse events of Grade 3 or higher were only observed in 2 (6.3%) of 32 patients.ConclusionStandard chemotherapy used for general-aged GC patients has similar efficacy, reduced toxicity, and higher intensity in GCYA patients.

Gastric Cancer in Young Adults: A Different Clinical Entity from Carcinogenesis to Prognosis

“…For general-aged GC patients, the standard treatment regimen is systemic chemotherapy, based on the results of randomized controlled trials [78][79][80]. Although GCYA only accounts for a minority of cases in these RCTs, another study that was focused on young patients found that standard chemotherapy may have similar efficacy for these patients [81]. With favorable general conditions and organ function, GCYA patients experienced less adverse events, which may facilitate intensive therapy [81].…”

“…Although GCYA only accounts for a minority of cases in these RCTs, another study that was focused on young patients found that standard chemotherapy may have similar efficacy for these patients [81]. With favorable general conditions and organ function, GCYA patients experienced less adverse events, which may facilitate intensive therapy [81]. With regard to subsequent treatment outcomes after firstline chemotherapy, data were limited in GCYA patients.…”

“…With regard to subsequent treatment outcomes after firstline chemotherapy, data were limited in GCYA patients. GCYA patients with diffuse-type GC tend to have peritoneal metastasis after first-line chemotherapy, and early detection is much more difficult than metastasis in other organs, which may worsen the outcomes [81].…”

Gastric cancer for young adults: Case series of three cases

“…Gastric cancer is the fifth most common malignancy in the world [ 1 , 2 ]. It is considered to be the second most common cause of cancer-related death, with a higher incidence in the elderly [ 3 , 4 ]. In the literature, gastric cancer occurs in subjects over the age of 50, although there is an increase in the relative proportion of gastric cancers in young people compared with adults [ 2 , 4 ].…”

“…It is considered to be the second most common cause of cancer-related death, with a higher incidence in the elderly [ 3 , 4 ]. In the literature, gastric cancer occurs in subjects over the age of 50, although there is an increase in the relative proportion of gastric cancers in young people compared with adults [ 2 , 4 ]. Data on the clinical, biological and prognostic characteristics of gastric cancer in young patients are still controversial.…”