1418P Chronological improvement in the survival of advanced gastric cancer patients in the past 15 years

Abstract

Recent clinical trials have shown that the median overall survival (OS) of advanced gastric cancer (AGC) patients (pts) has reached 11–17 months. However, in practice, the prognosis remains unclear. The objective of this study was to evaluate the clinicopathological features and survival of pts with AGC in the past 15 years. We retrospectively collected data on 1,355 AGC pts who received first-line chemotherapy (CTx) between Jan 2005 and Mar 2019 at a single institution. We compared the survival between four periods: Jan 2005–Dec 2007 (period A); Jan 2008–Feb 2011 (period B; after the establishment of fluoropyrimidines plus platinum agents as standard CTx); Mar 2011–May 2015 (period C; after the approval of trastuzumab); and Jun 2015–Mar 2019 (period D; after approval of ramucirumab [Ram]). With a median follow-up time of 13.1 months, there were 312 pts in period A, 333 pts in period B, 393 pts in period C, and 317 pts in period D. The characteristics in each period were not different, except for the proportion of those with prior gastrectomy (49%, 39%, 38%, and 34%) and HER2 testing (33%, 55%, 93%, and 100%). The rates of receiving second-, third-, and fourth-line CTx were not different between each period. The frequency of exposure to irinotecan (39%, 49%, 39%, and 26%) gradually decreased, whereas that of Ram (0%, 4%, 10%, and 64%) and nivolumab (0%, <1%, 8%, and 43%) increased. Pts in period D had significantly longer OS than those in period A (median OS, 15.7 vs. 12.4 months; adjusted hazard ratio [aHR], 0.79; p=0.02). Over time, the 5-year OS rate significantly improved (2%, 2%, 6%, and 10%). The OS of the pts with liver metastasis (LM) in period D remarkably improved compared with those in period A (median OS, 19.3 vs. 12.4 months; aHR, 0.61; p<0.01).Table: 1418PPeriod APeriod BPeriod CPeriod DMedian OS (months)12.412.713.815.7aHR (95% CI)Ref.0.98 (0.83–1.15)0.94 (0.78–1.14)0.79 (0.65–0.97)Median PFS of first-line (months)4.35.16.06.6aHR (95% CI)Ref.1.00 (0.84–1.18)0.83 (0.69–1.00)0.76 (0.62–0.92)Median PPS of first-line (months)6.26.66.67.5aHR (95% CI)Ref.0.97 (0.82–1.16)1.13 (0.92–1.37)0.99 (0.80–1.23)Median OS of patients with LM (months)12.411.014.319.3aHR (95% CI)Ref.1.11 (0.81–1.53)0.97 (0.67–1.39)0.61 (0.40–0.92) Open table in a new tab A change in clinical strategy, including gastrectomy, HER2 testing, and the approval of new drugs, may be associated with improved OS in pts with AGC. In the last 4 years, a remarkable improvement has been observed in pts with LM.