Yaşlı metastatik mide kanserli hastalarda tek başına oral kapesitabin ile platin kombinasyonlarının karşılaştırılması

Abstract

Background: Gastric cancer is responsible for a considerable proportion of all cancer-related deaths. Elderly cancer patients are often ignored in prospective studies in which the efficacy of chemotherapy is evaluated, although more than half of all gastric cancer cases are over the age of 70 years. The present study aims to evaluate the efficacy and feasibility of capecitabine-based chemotherapies in geriatric patients with gastric cancer. Methods: A total of 81 patients over the age of 65 years who received chemotherapy for metastatic gastric cancer at two oncology centers between 2012 and 2017 were included in the study. The medical records of the patients were evaluated retrospectively, and the patients and their performance status were evaluated using the American Joint Committee on Cancer staging system and the World Health Organisation scale, respectively. Results: The mean age was 74 years. The male gender and the adenocarcinoma histological type were seen in higher rates. Most of the patients underwent capecitabine-cisplatin chemotherapy, and the mean follow-up was 42 months. The median overall survival of the groups of patients receiving capecitabine-cisplatin, capecitabine-oxaliplatin and capecitabine was 8 months, 10.7 months and 8.9 months, respectively, indicating no statistically significant differences between the groups (p=0.467). The median overall survival of all patients was found to be 8.7. The progression-free survival between the different chemotherapy subgroups was not statistically significant (p=0.59). The most common side effect was found to be anemia. Grade 3–4 adverse effects were similar between the arms of the study (p=0.725). A statistically significant increase was found in the mortality risk with an increased number of metastatic sites in a multivariate analysis (p=0.001). No correlation was found between the chemotherapy protocols and mortality risk (p=0.472). Adverse effects such as stomatitis, nausea/vomiting, neuropathy, neutropenic fever and nephrotoxicity, independent of chemotherapy, were statistically and significantly associated with the mortality risk (p=0.045, p=0.047, p=0.036, p=0.02 and p=0.049, respectively). Conclusions: Our study results show that adverse effects such as stomatitis, nausea/vomiting, neutropenic fever, nephrotoxicity and neuropathy increase the mortality risk which suggest that particularly oral health care, the application of appropriate antiemetic treatments, the close follow-up of kidney function tests and adequate hydration, protective infection barrier measures and effective treatment of neuropathy associated with chronic diseases are as important as chemotherapy in geriatric cases.