Abstract
IntroductionCombination chemotherapy is a standard treatment approach in advanced gastric cancer. However, combination chemotherapy for advanced gastric cancer is often associated with severe treatment related toxicities, and most oncologists are reluctant to perform combination chemotherapy in patients with poor clinical condition. We retrospectively investigated efficacy and tolerability of single agent chemotherapy in recurred or metastatic gastric cancer patients with poor performance status. MethodsWe reviewed advanced gastric adenocarcinoma patients received single agent first-line palliative chemotherapy due to poor clinical condition from June 2007 to December 2010. 125 patients with Eastern Cooperative Oncology Group performance status (ECOG PS) 2-3, whose general condition did not allow combination chemotherapy, were enrolled. Four single agents were used: TS-1 (n=63), paclitaxel (n=42), irinotecan (n=15), and capecitabine (n=5). The primary endpoint of this study was overall survival (OS) and the secondary endpoints were safety, response rate, and progression free survival (PFS). ResultsThe median age was 58 years with a range of 24-81 years. Objective tumor response rate (19%) was 19% for TS-1, 21% for paclitaxel, 13% for irinotecan, and 20% for capecitabine. The percentage of stable disease was 35%, resulting in the disease control rate of 54%. The estimated median PFS was 3.9 months (95% CI, 2.7-5.0 months) and the median OS was 9.1 months (95% CI, 7.7-10.5 months). The overall 1 year survival rate was 31.2 %. At multivariate analysis, independent prognostic parameters for OS were chemotherapy regimen (P=0.03), bone metastasis (HR 2.4, 95% CI 1.08-5.31, P=0.031), second-line chemotherapy (HR 0.4, 95% CI 0.26-0.61, P=0.001), chemotherapy response (CR+PR) (HR 0.24, 95% CI 0.09-0.63, P=0.004), and abnormal Glasgow prognostic score (HR 2.11, 95% CI 1.4-3.16, P=0.001). ConclusionSingle agent first-line palliative chemotherapy have relatively good treatment efficacy in recurred or metastatic gastric cancer patients with poor performance status. [Display omitted]
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