Abstract
This study was to determine the efficacy and safety of pemetrexed based chemotherapy in treating patients with metastatic gastric cancer who failed to respond to first and (or) second line chemotherapy. Metastatic gastric cancer patients who failed first and (or) second line chemotherapy, were enrolled. All patients were recruited from Jiangsu Cancer Hospital and Research Institute, and were treated with pemetrexed 500 mg/m2 (intravenous; on day 1), and a platinum (or irinotecan) every 3 weeks until disease progression, or intolerable toxicity. Evaluation on efficacy was conducted after two cycles of chemotherapy using the Response Evaluation Criteria for Solid Tumors. Toxicity was recorded according to National Cancer Institute Common Terminology Criteria for Adverse Events version 3.0. From Jun 2011 to May 2013, 23 patients were enrolled. All eligible 23 patients completed at least 2 cycles of chemotherapy with pemetrexed based chemotherapy, and were evaluable. Their median age was 55 years (range 40 to 78 years). Seventeen patients were male and 6 female. Three patients (13%) achieved partial response, five patients (22%) stable, 15 patients (65%) with disease progression, and none with complete response. Grade 2 neutrophil suppression occurred in 4.3%, grade 3 in 13% of patients, and no grade 4 was reported. Thrombocytopenia was encountered as follows: 4.3% grade 2, 4.3% grade 3 and 4.3% grade 4. Incidence of anemia was 34.8% in grade 2, 8.7% grade 3 and 0% grade 4. Only 4.3% of patients required packed red blood cell infusion. Elevated transaminase were 4.3% in grade 2 and 0% in grade 3 or 4. Other toxicity included oral mucositis. Pemetrexed based chemotherapy is mildly effective in treating patients with metastatic gastric cancer with tolerable toxicity.
Highlights
Gastric cancer remains one of the leading causes of cancer death worldwide (Parkin et al, 2002)
Twenty patients received pemetrexed combined with other agents, and 3 patients were treated with pemetrexed alone (Table 2)
Patients with metastatic gastric cancer are associated with poorer prognosis compared with those with locally advanced disease (Ross et al, 2002)
Summary
Gastric cancer remains one of the leading causes of cancer death worldwide (Parkin et al, 2002). Patients suffering from advanced gastric cancer (AGC) remain a therapeutic challenge for medical oncologists. Randomized trials proved that palliative chemotherapy brings survival benefits over best supportive care for metastatic gastric cancer (Wagner et al, 2010). Despite increasing evidence that appropriate management for fit patients is chemotherapy, no combination is considered as a standard of care. Active chemotherapeutic agents in first line chemotherapy for advanced gastric cancer include 5-fluorouracil, cisplatin, and anthracyclines (Ohtsu, 2008). New generation agents, including taxanes, ironotecan, oxaliplatin and pemetrexed are reported to be active in treating patients with gastric cancer (Pozzo et al, 2008). The response rate of above-mentioned single agent is around 10 to 25%, with significant toxicities
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