Abstract
The definition of the standard chemotherapy regimen for advanced gastric cancer is still a matter of debate. Aim of our analysis was to retrospectively assess whether an intensive, three-drugs, front line approach could be comparable to a sequential (two-drugs front line then second line) in terms of RR (response rate), PFS (progression free survival) and OS (overall survival) in advanced gastric cancer patients in the clinical practice. Patients with metastatic gastric cancer who have received a first-line combination chemotherapy with a two or three-drugs regimen were included in our analysis. We divided our patients into two groups, A and B, based on the first line chemotherapy administered (group A = three drugs; group B = two drugs). A total of 425 patients were eligible for our analysis. 216 patients (50.8 %) received three chemotherapeutic agents (group A) and 209 patients (49.2 %) received a two drugs regimen as first-line combination chemotherapy (group B). RR for group A and B was 44 and 29.6 %, respectively (p = 0.0005), median PFS was 7.3 months in group A and 4.5 months in group B (p = 0.0007). No significant difference was found in terms of OS. The addition of a third drug to a doublet chemotherapy regimen appeared more active in terms of response rate and PFS. However median OS resulted comparable. On this basis, the use of a sequential approach may represent a reasonable strategy for patients unwilling or unable to undergo a more intensive treatment without compromising OS.
Highlights
Gastric cancers remains one of the leading causes of cancer mortality worldwide even thought its incidence has been decreasing in recent years
In the daily clinical practice, administering a three-drugs treatment may prove difficult in advanced gastric cancer patients, who often present with multiple co-morbidities and poor performance status
Characteristics of the patients A total of 425 advanced gastric cancer patients treated with chemotherapy were included in our analysis
Summary
Gastric cancers remains one of the leading causes of cancer mortality worldwide even thought its incidence has been decreasing in recent years. More than half of gastric carcinomas are diagnosed in an advanced stage, when resection is no longer possible In this setting chemotherapy is still the main treatment option for patients with advanced disease. In the daily clinical practice, administering a three-drugs treatment may prove difficult in advanced gastric cancer patients, who often present with multiple co-morbidities and poor performance status. In this scenario a doublet with a fluoropyrimidine and platinum is still an acceptable alternative and remains the cornerstone of gastric cancer treatment. The definition of the standard chemotherapy regimen for advanced gastric cancer remains a matter debate
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