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Fang T, Yin X, Wang Y, Zhang L, Yang S, Jiang X, Xue Y. Clinical significance of systemic inflammation response index and platelet-lymphocyte ratio in patients with adenocarcinoma of the esophagogastric junction and upper gastric cancer. Heliyon 2024; 10:e26176. [PMID: 38420481 PMCID: PMC10900425 DOI: 10.1016/j.heliyon.2024.e26176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/02/2024] Open
Abstract
Background Tumor immunity plays an important role in assessing the tumor progression. The purpose of this study was to investigate the prognostic value of combined systemic inflammation response index (SIRI) and platelet-lymphocyte ratio (PLR) of gastroesophageal junction cancer (AEG) and upper gastric cancer (UGC) patients. Methods In this retrospective study, patients from 2003 to 2014 were divided into training and validation sets. The prognostic accuracy of each variable was compared using time-independent ROC analysis. The scoring system was calculated by cut-off values of SIRI and PLR in 5-year. Kaplan-Meier and Log-rank tests were used to analyze overall survival (OS). Chi-square test was used to analyze the association between clinical characteristics and the scoring system. Univariate and multivariate analyses based on the competitive risk regression model were used to analyze independent predictors of death due to AGC and UGC. R software was used to construct the Nomogram model of risk assessment. Results Patients with SIRI-PLR = 2 had worse survival time than those with 0 and 1 (P < 0.001) and more suitable for postoperative adjuvant chemotherapy (P = 0.002). High PLR patients were more suitable for proximal gastrectomy (P = 0.049). SIRI-PLR were independent predictors in training set (P < 0.001), which could be combined with age, pTNM stage and postoperative chemotherapy to construct Nomogram for predicting OS. Conclusions Preoperative SIRI-PLR score was an independent predictor for patients with AEG and UGC. The Nomogram model constructed by age, SIRI-PLR, pTNM stage and postoperative chemotherapy can correctly predict the prognosis of patients.
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Affiliation(s)
- Tianyi Fang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, 150081, China
| | - Xin Yin
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, 150081, China
| | - Yufei Wang
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, 150081, China
| | - Lei Zhang
- Department of Pathology, Harbin Medical University, Harbin, 150081, China
| | - Shuo Yang
- Department of Pathology, Harbin Medical University, Harbin, 150081, China
| | - Xinju Jiang
- Department of Pathology, Harbin Medical University, Harbin, 150081, China
| | - Yingwei Xue
- Department of Gastroenterological Surgery, Harbin Medical University Cancer Hospital, Harbin Medical University, Harbin, 150081, China
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Lu Z, Wada R, Salas M, Singh J, Kawaguchi Y, Belli AJ, Abutarif M, Garimella T. Use of Real-World Evidence in a Virtual Bridging Analysis for a Human Epidermal Growth Factor Receptor 2-Targeted Antibody-Drug Conjugate in Gastric Cancer. J Clin Pharmacol 2023; 63:1244-1255. [PMID: 37377133 DOI: 10.1002/jcph.2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 06/23/2023] [Indexed: 06/29/2023]
Abstract
This study bridged pharmacokinetic, efficacy, and safety clinical trial data from Japan to a Western population using real-world evidence (RWE) to investigate the antibody-drug conjugate trastuzumab deruxtecan (T-DXd) in the treatment of human epidermal growth factor receptor 2 (HER2)-positive advanced gastric cancer. Using population pharmacokinetic and exposure-response (efficacy/safety) models, exposure-efficacy data from 117 patients and exposure-safety data from 158 patients in Japan who received T-DXd 6.4 mg/kg as second-line or later treatment were bridged to RWE including covariate information from 25 Western patients with HER2-positive gastric cancer who received second-line or later T-DXd treatment. Pharmacokinetic simulations indicated that intact T-DXd and released drug (DXd) steady-state exposures were comparable between Western patients and patients from Japan; the Western/Japan ratio of exposure medians ranged from 0.82 (T-DXd steady-state minimum concentration) to 1.18 (DXd steady-state maximum concentration). Exposure-efficacy simulations estimated a confirmed objective response rate of 28.6% (90% confidence interval, 20.8-38.4) in real-world Western patients versus 40.1% (90% confidence interval, 33.5-47.0) in patients from Japan, possibly because of checkpoint inhibitor use in 4% versus 30% of patients, respectively. Western patients had a higher estimated rate of serious adverse events than patients from Japan (42.2% vs 34.6%); however, the rate of interstitial lung disease was lower (less than 10%) in Western patients. Overall, T-DXd was predicted to have meaningful clinical activity and a manageable safety profile in Western patients with HER2-positive gastric cancer. Using RWE, bridging analysis supported US approval of T-DXd 6.4 mg/kg in advanced gastric cancer before a clinical trial was completed in Western patients.
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Affiliation(s)
- Zheng Lu
- Daiichi Sankyo Inc., Basking Ridge, NJ, USA
| | - Russ Wada
- Certara Inc., Princeton, NJ, USA
- QuanTx Consulting, Mountain View, CA, USA
| | - Maribel Salas
- Daiichi Sankyo Inc., Basking Ridge, NJ, USA
- Center for Clinical Epidemiology and Biostatistics/Center for Pharmacoepidemiology Research and Training, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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3
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Chen J, Zou X. Prognostic significance of lactate dehydrogenase and its impact on the outcomes of gastric cancer: a systematic review and meta-analysis. Front Oncol 2023; 13:1247444. [PMID: 37727205 PMCID: PMC10505930 DOI: 10.3389/fonc.2023.1247444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/07/2023] [Indexed: 09/21/2023] Open
Abstract
Background The prognostic significance of lactate dehydrogenase (LDH) and its impact on the outcomes of gastric cancer (GC) is still unclear. We assessed the link between the levels of LDH and the overall survival (OS) and disease-free survival (DFS) in GC patients. Methods A comprehensive search (both electronic and manual) was carried out in PubMed via MEDLINE, Web of Science (WoS), Experta Medical Database (Embase), and CENTRAL (Cochrane Library) databases for citations that evaluated the strength of association between LDH cut-off levels and OS and/or DFS in GC. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using a random-effects model, and heterogeneity was assessed. Results Eighteen studies with 5328 patients were included in our review. The overall pooled HR for OS was 1.48 (95% CI: 1.22-1.80) with high heterogeneity (I2 = 86%). Subgroup analyses showed that the link between LDH and OS was more prominent in Caucasian (HR 1.50 95% CI [0.80, 2.81], p=0.21) than in Asian cohorts (HR, 1.51 95% CI [1.21, 1.87], p=0.002). No significant overall association between LDH and OS (HR = 1.12, 95% CI: 0.76-1.65, p = 0.58) was found. Similar subgroup analyses results were reported for the association between LDH and DFS. Conclusion In patients with GC, elevated LDH levels may correlate with worse OS and DFS, but the association is not significant. LDH is a significant predictor of OS but not of DFS. Further studies with larger sample sizes and more standardized criteria for defining elevated LDH levels are needed to confirm our findings. Systematic review registration https://www.crd.york.ac.uk/prospero, identifier CRD42023412449.
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Affiliation(s)
| | - Xiaoyue Zou
- Department of Clinical Laboratory, First affiliated Hospital of Huzhou University, Huzhou, China
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4
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Ghidini M, Hochster H, Doi T, Van Cutsem E, Makris L, Takahashi O, Benhadji KA, Mansoor W. Body weight loss as a prognostic and predictive factor in previously treated patients with metastatic gastric cancer: post hoc analyses of the randomized phase III TAGS trial. Gastric Cancer 2023; 26:626-637. [PMID: 37106214 PMCID: PMC10284730 DOI: 10.1007/s10120-023-01393-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND Body weight loss (BWL) is a negative prognostic factor in metastatic gastric or gastroesophageal junction cancer (mGC/GEJC). In the phase III TAGS study, trifluridine/tipiracil improved survival versus placebo in third- or later-line mGC/GEJC. These retrospective analyses examined the association of early BWL with survival outcomes in TAGS. METHODS Efficacy and safety were assessed in patients who experienced < 3% or ≥ 3% BWL from treatment start until day 1 of cycle 2 (early BWL). The effect of early BWL on overall survival (OS) was assessed by univariate and multivariate analyses. RESULTS Body weight data were available for 451 of 507 (89%) patients in TAGS. In the trifluridine/tipiracil and placebo arms, respectively, 74% (224/304) and 65% (95/147) experienced < 3% BWL, whereas 26% (80/304) and 35% (52/147) experienced ≥ 3% BWL at cycle 1 end. Median OS was longer in < 3% BWL versus ≥ 3% BWL subgroups (6.5 vs 4.9 months for trifluridine/tipiracil; 6.0 vs 2.5 months for placebo). In univariate analyses, an unadjusted HR of 0.58 (95% CI, 0.46-0.73) for the < 3% vs ≥ 3% BWL subgroup indicated a strong prognostic effect of early BWL. Multivariate analyses confirmed early BWL as both prognostic (P < 0.0001) and predictive (interaction P = 0.0003) for OS. Similar results were obtained for progression-free survival. Any-cause grade ≥ 3 adverse events were reported in 77% and 82% of trifluridine/tipiracil-treated and 45% and 67% of placebo-treated patients with < 3% and ≥ 3% BWL, respectively. CONCLUSIONS In TAGS, early BWL was a strong negative prognostic factor for OS in patients with mGC/GEJC receiving third- or later-line treatment.
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Affiliation(s)
- Michele Ghidini
- Oncology Division, Azienda Socio Sanitaria Territoriale di Cremona, Azienda Ospedaliera di Cremona, Viale Concordia 1, 26100, Cremona, Italy.
| | - Howard Hochster
- Gastrointestinal Oncology, Rutgers Cancer Institute, New Brunswick, NJ, USA
| | - Toshihiko Doi
- Department of Experimental Therapeutics, National Cancer Center Hospital East, Chiba, Japan
| | - Eric Van Cutsem
- Digestive Oncology, University Hospitals Gasthuisberg, Leuvain, Belgium
| | | | | | | | - Wasat Mansoor
- Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester, UK
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Cascinu S, Di Bartolomeo M, Lonardi S, Beretta G, Fornaro L, De Vita F. The evolving strategies for the management of patients with metastatic gastric cancer: A narrative review and expert opinion. Front Med (Lausanne) 2022; 9:1002435. [PMID: 36590964 PMCID: PMC9799163 DOI: 10.3389/fmed.2022.1002435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Gastric cancer (GC) is recognized as one of the most common deadly malignancies worldwide and about 40-50% of patients present at diagnosis with an unresectable disease due to a locally advanced or already metastatic condition. Recently, therapeutic options for management of metastatic GC (mGC) have been approved allowing a potential improvement of patient cancer treatment response and also an establishment of a continuum of care for this aggressive disease. This report is the result of a literature review by an expert panel. The aim of this document is to provide evidence, wherever it is lacking, to provide expert opinion directed at strategic management of mGC, and in particular aspect at practical management where appropriate guidelines are not available. Treatment landscape with new therapeutic strategies for third line and beyond, role of imaging, prognostic factors, symptoms, and markers as well as the importance of multidisciplinary approach particularly the nutritional aspects are discussed.
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Affiliation(s)
- Stefano Cascinu
- Comprehensive Cancer Center, IRCCS Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy,*Correspondence: Stefano Cascinu,
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Sara Lonardi
- Medical Oncology Unit 3, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | | | - Lorenzo Fornaro
- Unit of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ferdinando De Vita
- Oncologia Medica - Dipartimento di Medicina di Precisione, Università degli Studi della Campania Luigi Vanvitelli, Naples, Italy
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Lavacchi D, Giommoni E, Cianchi F, Antonuzzo L. Treatment Strategy for Oligometastatic Gastric Cancer: Brief Considerations. J Gastrointest Cancer 2022; 54:6-8. [PMID: 35094291 DOI: 10.1007/s12029-021-00792-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Daniele Lavacchi
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Elisa Giommoni
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy
| | - Fabio Cianchi
- Unit of Digestive Surgery, Careggi University Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Lorenzo Antonuzzo
- Clinical Oncology Unit, Careggi University Hospital, Florence, Italy. .,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
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He K, Chen C, Xia L, Si L, Pan X, Sun Z, Wang Y, Jiang Y, Shi Y, Zhou B, Wang S, Han J, Shen B, Zhou G, Lu J, Wang X. Deep muscularis propria tumor invasion without lymph node metastasis as a unique subclassification of stage IB gastric cancer: a retrospective study. BMC Gastroenterol 2022; 22:30. [PMID: 35062873 PMCID: PMC8783482 DOI: 10.1186/s12876-021-02090-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 12/22/2021] [Indexed: 12/26/2022] Open
Abstract
Background The prognosis difference based on the depth of tumor muscularis propria invasion in gastric cancer (GC) was still debated, and therapy strategy for stage IB GC patient required further investigation. Methods A total of 380 patients with pT2 GC after radical surgery were retrospectively analyzed, including 185 in superficial muscularis propria (sMP) group and 195 in deep muscularis propria (dMP) group. Results The overall survival (OS) was significantly better for patients in sMP group than for patients in dMP group (P = 0.007). In multivariate analysis, depth of tumor invasion, pN stage, age, primary location, positive expression of p53, elevated maximal LDH, elevated initial CA19-9 and AFP level were independent prognostic factors for OS. The sMP group had a significantly better OS than dMP group (P = 0.014) in pN0 stage. After further stratification, the survival outcomes were not significantly different between deep muscularis propria tumor invasion without lymph node metastasis (dMPN0) group (stage IB) and superficial muscularis propria tumor invasion with stage 1–2 lymph node metastasis (sMPN1–2) group (stage II) (P = 0.100). Patients with adjuvant chemotherapy had a statistically better survival than those without in dMPN0 group (P = 0.045) and dMPN0 patients with adjuvant chemotherapy had better OS than sMPN1–2 patients (P = 0.015). In addition, greater postoperative survival could be observed in sMPN0 patients than dMPN0 patients in p53-positive group (P = 0.002), and similar OS could be seen between dMPN0 patients with p53-positive and T2N1–2 patients (P = 0.872). Conclusion As a unique subclassification of stage IB GC, appropriate adjuvant chemotherapy should be considered for patients with dMPN0 stage. In addition, positive expression of p53, elevated LDH could be potential factors in identifying the different prognoses for stage IB GC patients. Supplementary Information The online version contains supplementary material available at 10.1186/s12876-021-02090-z.
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Bando E, Ji X, Kattan MW, Bencivenga M, de Manzoni G, Terashima M. Development and validation of pretreatment nomogram for disease-specific mortality in gastric cancer-A competing risk analysis. Cancer Med 2021; 10:7561-7571. [PMID: 34628732 PMCID: PMC8559461 DOI: 10.1002/cam4.4279] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 08/16/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022] Open
Abstract
Background In several reports, gastric cancer nomograms for predicting overall or disease‐specific survival have been described. The American Joint Committee on Cancer (AJCC) introduced the attractiveness of disease‐specific mortality (DSM) as an endpoint of risk model. This study aimed to develop the first pretreatment gastric cancer nomogram for predicting DSM that considers competing risks (CRs). Methods The prediction model was developed using data for 5231 gastric cancer patients. Fifteen prognosticators, which were registered at diagnosis, were evaluated. The nomogram for DSM was created as visualizations of the multivariable Fine and Gray regression model. An independent cohort for external validation consisted of 389 gastric cancer patients from a different institution. The performance of the model was assessed by discrimination (Harrell's concordance (C)‐index), calibration, and decision curve analysis. DSM and CRs were evaluated, paying special attention to host‐related factors such as age and Eastern Cooperative Oncology Group performance status (ECOG PS), by using Gray's univariable method. Results Fourteen prognostic factors were selected to develop the nomogram. The new nomogram for DSM exhibited good discrimination. Its C‐index of 0.887 surpassed that of the American Joint Committee on Cancer (AJCC) clinical staging (0.794). The C‐index was 0.713 (AJCC, 0.582) for the external validation cohort. The nomogram showed good performance internally and externally, in the calibration and decision curve analysis. Host‐related factors including age and ECOG PS, were strongly correlated with competing risks. Conclusions The newly developed nomogram accurately predicts DSM, which can be used for patient counseling in clinical practice.
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Affiliation(s)
- Etsuro Bando
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Xinge Ji
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Michael W Kattan
- Department of Quantitative Health Sciences, The Cleveland Clinic, Cleveland, OH, USA
| | - Maria Bencivenga
- Division of General and Upper Gastrointestinal Surgery, Department of Surgery, University of Verona, Verona, Italy
| | - Giovanni de Manzoni
- Division of General and Upper Gastrointestinal Surgery, Department of Surgery, University of Verona, Verona, Italy
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Ramaswamy A, Bajaj K, Talwar V, Prabhash K, Batra U, Dhabhar B, Sharma M, Ghadyalpatil N, CT S, Goyal G, Muzamil J, Bhatt A, Jain P, Ranade A, Kamath M, Gawande JP, Thippeswamy R, Mirani J, Reddy N, Ganguly S, Mishra SK, Madabhavi I, HP S, Panda SS, Patil S, Bhargava P, Ostwal V. Ramucirumab in Indian Patients with Advanced Gastric Cancer—Does Borderline Performance Status and Heavy Burden of Disease in Real World Practice Impact Clinical Benefit? South Asian J Cancer 2021; 11:24-30. [PMID: 35833042 PMCID: PMC9273313 DOI: 10.1055/s-0041-1728980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background
Ramucirumab is considered a standard of care as second-line therapy (CT2) in advanced gastric cancers (AGCs). The aim of this study was to assess practice patterns and outcomes with ramucirumab among Indian patients with AGCs.
Materials and Methods
A computerized clinical data entry form was formulated by the coordinating center's (Tata Memorial Hospital) medical oncologists and disseminated through personal contacts at academic conferences as well as via email for anonymized patient data entry. The data was analyzed for clinical characteristics, response rates, and survival outcomes.
Results
A total of 26 physicians contributed data, resulting in 55 patients receiving ramucirumab and being available for analysis. Median age was 53 years (range: 26–78), 69.1% of patients had greater than two sites of disease, and baseline Eastern Cooperative Oncology Group's performance score (ECOG PS) ≥ 2 was seen in 61.8% of patients. Ramucirumab was used as monotherapy in 10.9% of patients, while the remaining 89.1% received ramucirumab combined with chemotherapy. Median event-free survival (EFS) and median overall survival (OS) with ramucirumab were3.53 months (95% CI: 2.5–4.57) and 5.7 months (95% CI: 2.39–9.0), respectively. Common class specific grade adverse events seen with ramucirumab included gastrointestinal (GI) hemorrhage (9.1% - all grades) and uncontrolled hypertension (Grade 3/4 - 3.6%).
Conclusions
Ramucirumab appears to have similar efficacy in Indian AGC patients when compared with real-world data from other countries in terms of median EFS, but OS appears inferior due to more patients having borderline ECOG PS and high metastatic disease burden. GI hemorrhages appear more common than published data, although not unequivocally related to ramucirumab.
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Affiliation(s)
- Anant Ramaswamy
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Kripa Bajaj
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Vineet Talwar
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Kumar Prabhash
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Ullas Batra
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | - Boman Dhabhar
- Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Mansi Sharma
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | | | - Satish CT
- HCG Group of Hospital, Bangalore, Karnataka, India
| | - Gautam Goyal
- Department of Oncology, Max Super Speciality Hospital, Mohali, Punjab, India
| | - Javvid Muzamil
- Department of Medical Oncology, Khyber Superspeciality Institute, Srinagar, Kashmir, J&K, India
| | - Amit Bhatt
- Avinash Cancer Clinic, Pune, Maharashtra, India
| | - Parveen Jain
- Department of Oncology, Rajiv Gandhi Cancer Institute and Research Centre, Rohini, Delhi, India
| | | | | | - Jayant Pundlik Gawande
- Aditya Birla Memorial Hospital, Aditya Birla Hospital Marg, Chinchwad, Pune, Maharashtra, India
| | - Ravi Thippeswamy
- Sri Shankara Cancer Hospital Basavangudi, Bangalore, Karnataka, India
| | - Jimmy Mirani
- Department of Medical Oncology, Wockhardt Hospitals, Mumbai, Maharashtra, India
| | - Neelesh Reddy
- Columbia Asia Hospital Yeshwantpur, Bangalore, Karnataka, India
| | - Sandip Ganguly
- Department of Medical Oncology, Tata Medical Center, Kolkata, West Bengal, India
| | | | | | | | - Soumya Surath Panda
- Department of Medical Oncology, IMS & SUM Hospital, Bhubaneswar, Odisha, India
| | - Shekar Patil
- HCG Group of Hospital, Bangalore, Karnataka, India
| | - Prabhat Bhargava
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
| | - Vikas Ostwal
- Department of Medical Oncology, TMH, Homi Bhabha National University, Mumbai, Maharashtra, India
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Fornaro L, Spallanzani A, de Vita F, D’Ugo D, Falcone A, Lorenzon L, Tirino G, Cascinu S. Beyond the Guidelines: The Grey Zones of the Management of Gastric Cancer. Consensus Statements from the Gastric Cancer Italian Network (GAIN). Cancers (Basel) 2021; 13:1304. [PMID: 33804024 PMCID: PMC8001719 DOI: 10.3390/cancers13061304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 01/19/2021] [Accepted: 03/11/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Management of gastric and gastroesophageal junction (GEJ) adenocarcinoma remains challenging, because of the heterogeneity in tumor biology within the upper gastrointestinal tract. Daily clinical practice is full of grey areas regarding the complexity of diagnostic, staging, and therapeutic procedures. The aim of this paper is to provide a guide for clinicians facing challenging situations in routine practice, taking a multidisciplinary consensus approach based on available literature. METHODS The GAIN (GAstric cancer Italian Network) group was established with the aims of reviewing literature evidence, discussing key issues in prevention, diagnosis, and management of gastric and GEJ adenocarcinoma, and offering a summary of statements. A Delphi consensus method was used to obtain opinions from the expert panel of specialists. RESULTS Forty-nine clinical questions were identified in six areas of interest: role of multidisciplinary team; risk factors; diagnosis; management of early gastric cancer and multimodal approach to localized gastric cancer; treatment of elderly patients with locally advanced resectable disease; and treatment of locally advanced and metastatic cancer. CONCLUSIONS The statements presented may guide clinicians in practical management of this disease.
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Affiliation(s)
- Lorenzo Fornaro
- Department of Translational Medicine, Division of Medical Oncology, AOU Pisana, 56126 Pisa, Italy;
| | - Andrea Spallanzani
- Department of Oncology and Hematology, University Hospital of Modena, 41125 Modena, Italy;
| | - Ferdinando de Vita
- Department of Precision Medicine, Division of Medical Oncology, School of Medicine, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy; (F.d.V.); (G.T.)
| | - Domenico D’Ugo
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (D.D.); (L.L.)
| | - Alfredo Falcone
- Department of Translational Medicine, Division of Medical Oncology, University of Pisa, 56126 Pisa, Italy;
| | - Laura Lorenzon
- General Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Catholic University, 00168 Rome, Italy; (D.D.); (L.L.)
| | - Giuseppe Tirino
- Department of Precision Medicine, Division of Medical Oncology, School of Medicine, University of Campania ‘Luigi Vanvitelli’, 81100 Caserta, Italy; (F.d.V.); (G.T.)
| | - Stefano Cascinu
- Medical Oncology, Università Vita-Salute San Raffaele, 20132 Milan, Italy
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11
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Giampieri R, Cantini L, Del Prete M, Bittoni A, Giglio E, Mandolesi A, Maccaroni E, Lanese A, Meletani T, Baleani MG, Bisonni R, Scarpelli M, Berardi R. An observational retrospective analysis of the main metastatic site and corresponding locoregional treatment as a prognostic factor in metastatic gastric cancer. Oncol Lett 2021; 21:267. [PMID: 33717264 PMCID: PMC7885158 DOI: 10.3892/ol.2021.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 11/18/2020] [Indexed: 12/24/2022] Open
Abstract
Despite novel drugs, the prognosis for patients with metastatic gastric cancer remains poor. In rare instances, locoregional therapies are used in addition to standard chemotherapy in patients with oligometastatic involvement. This type of approach has not been supported by solid published evidence. The aim of the present retrospective study was to assess the prognostic impact of factors such as metastatic site, tumour histology and locoregional treatment in patients with metastatic gastric cancer. A total of 184 patients with metastatic gastric or gastroesophageal junction adenocarcinoma who received at least one line of palliative therapy with doublet or triplet chemotherapy were enrolled in the current analysis. Median overall survival (OS) was 8.32 months (95% CI, 7.02–9.41) and median progression-free survival (PFS) was 4.16 months (95% CI, 3.24–5.08). Lung metastases vs. other sites of metastatic involvement [hazard ratio (HR), 0.27; P=0.0133] and intestinal histology (HR, 0.48; P=0.08) were significantly associated with an improved OS. Improved PFS was also observed (HR, 0.49; P=0.10 and HR, 0.72; P=0.08 for lung metastases and intestinal histology, respectively). Second line chemotherapy and locoregional treatment of metastases (surgery or radiotherapy) were associated with improved OS (HR, 0.52; P<0.0001 and HR, 0.35; P<0.0001, respectively). Multivariate analysis confirmed an independent prognostic role for OS only for locoregional treatment, second line treatment and intestinal histology. The present results suggested that the presence of lung metastases alone was not a relevant prognostic factor and was influenced by the availability of further lines of treatment or by locoregional treatments. Locoregional treatments in patients with oligometastatic disease should be offered as they allow prolonged survival in patients with otherwise relatively short life expectancy.
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Affiliation(s)
- Riccardo Giampieri
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy.,Clinical Oncology, Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Luca Cantini
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Michela Del Prete
- Medical Oncology, Azienda Ospedaliera di Fermo, I-63900 Fermo, Italy
| | | | - Enrica Giglio
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Alessandra Mandolesi
- Pathology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Elena Maccaroni
- Clinical Oncology, Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Andrea Lanese
- Clinical Oncology, Ospedali Riuniti Ancona, I-60126 Ancona, Italy
| | - Tania Meletani
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Maria Giuditta Baleani
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Renato Bisonni
- Medical Oncology, Azienda Ospedaliera di Fermo, I-63900 Fermo, Italy
| | - Marina Scarpelli
- Pathology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, I-60126 Ancona, Italy
| | - Rossana Berardi
- Clinical Oncology, Department of Clinical and Molecular Sciences, Marche Polytechnic University, I-60126 Ancona, Italy.,Clinical Oncology, Ospedali Riuniti Ancona, I-60126 Ancona, Italy
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12
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Kim HD, Ryu MH, Yoon S, Na YS, Moon M, Lee H, Song HG, Kang YK. Clinical implications of neutrophil-to-lymphocyte ratio and MDSC kinetics in gastric cancer patients treated with ramucirumab plus paclitaxel. Chin J Cancer Res 2020; 32:621-630. [PMID: 33223757 PMCID: PMC7666782 DOI: 10.21147/j.issn.1000-9604.2020.05.07] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Objective We aimed to investigate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) and myeloid-derived suppressor cells (MDSCs) in gastric cancer patients treated with second-line ramucirumab plus paclitaxel. Methods A total of 116 patients with advanced or metastatic gastric cancer who receive ramucirumab plus paclitaxel were prospectively enrolled. Fresh blood samples were collected before and after treatment, and flow cytometry was performed to assess the proportions of monocytic (mMDSCs) and granulocytic MDSCs (gMDSCs). Results Median age was 58 years and 71 (61.2%) patients were male. A baseline NLR≥2.94 was associated with significantly poorer progression-free survival (PFS) and overall survival (OS) vs. an NLR<2.94 (P=0.011 and P=0.002, respectively). In multivariate analysis, an NLR≥2.94 was independently associated with poorer PFS [hazard ratio (HR)=1.58; 95% confidence interval (95% CI): 1.01-2.49, P=0.046] and OS (HR=1.77; 95% CI: 1.04-3.04, P=0.036). While mMDSC counts did not significantly change following two cycles of therapy (P=0.530), gMDSC counts decreased significantly after two treatment cycles (P=0.025) but tended to increase in patients with progressive disease after two treatment cycles (P=0.098). A progressive increase in gMDSC counts (≥44%) was associated with a significantly shorter PFS and OSvs. a gMDSC count increase <44% (P=0.001 and P=0.003, respectively). Conclusions The baseline NLR may help guide clinical decisions during ramucirumab plus paclitaxel therapy for gastric cancer. Our gMDSC kinetics data warrant further clinical validation and mechanistic investigation.
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Affiliation(s)
- Hyung-Don Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Min-Hee Ryu
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | | | - Young-Soon Na
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Meesun Moon
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | - Hyungeun Lee
- Asan Institute for Life Science, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
| | | | - Yoon-Koo Kang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea
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13
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Tsang ES, Lim HJ, Renouf DJ, Davies JM, Loree JM, Gill S. Real-world treatment attrition rates in advanced esophagogastric cancer. World J Gastroenterol 2020; 26:6027-6036. [PMID: 33132652 PMCID: PMC7584053 DOI: 10.3748/wjg.v26.i39.6027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 06/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Over the last decade, multiple agents have demonstrated efficacy for advanced esophagogastric cancer (EGC). Despite the availability of later lines of therapy, there remains limited real-world data about the treatment attrition rates between lines of therapy.
AIM To characterize the use and attrition rates between lines of therapy for patients with advanced EGC.
METHODS We identified patients who received at least one cycle of chemotherapy for advanced EGC between July 1, 2017 and July 31, 2018 across six regional centers in British Columbia (BC), Canada. Clinicopathologic, treatment, and outcomes data were extracted.
RESULTS Of 245 patients who received at least one line of therapy, median age was 66 years (IQR 58.2-72.3) and 186 (76%) were male, Eastern Cooperative Oncology Group (ECOG) performance status 0/1 (80%), gastric vs GEJ (36% vs 64%). Histologies included adenocarcinoma (78%), squamous cell carcinoma (8%), and signet ring (14%), with 31% HER2 positive. 72% presented with de novo disease, and 25% had received previous chemoradiation. There was a high level of treatment attrition, with patients receiving only one line of therapy n = 122, 50%), two lines n = 83, 34%), three lines n = 34, 14%), and four lines n = 6, 2%). Kaplan-Meier analysis demonstrated improved survival with increasing lines of therapy (median overall survival 7.7 vs 16.6 vs 22.8 vs 40.4 mo, P < 0.05). On multivariable Cox regression, improved survival was associated with better baseline ECOG and increased lines of therapy (P < 0.05).
CONCLUSION The steep attrition rates between therapies highlight the unmet need for more efficacious early-line treatment options for patients with advanced EGC.
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Affiliation(s)
- Erica S Tsang
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Howard J Lim
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Daniel J Renouf
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Janine M Davies
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Jonathan M Loree
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
| | - Sharlene Gill
- Department of Medicine, BC Cancer, Vancouver V5Z 4E6, Canada
- Division of Medical Oncology, University of British Columbia, Vancouver V5Z 4E6, Canada
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14
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Cotes Sanchís A, Gallego J, Hernandez R, Arrazubi V, Custodio A, Cano JM, Aguado G, Macias I, Lopez C, López F, Visa L, Garrido M, Martínez Lago N, Fernández Montes A, Limón ML, Azkárate A, Pimentel P, Reguera P, Ramchandani A, Cacho JD, Martín Carnicero A, Granja M, Martín Richard M, Hernández Pérez C, Hurtado A, Serra O, Buxo E, Vidal Tocino R, Jimenez-Fonseca P, Carmona-Bayonas A. Second-line treatment in advanced gastric cancer: Data from the Spanish AGAMENON registry. PLoS One 2020; 15:e0235848. [PMID: 32735623 PMCID: PMC7394396 DOI: 10.1371/journal.pone.0235848] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/24/2020] [Indexed: 01/21/2023] Open
Abstract
Background Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice. Materials and methods The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS). Results 2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9–3.3) and 5.8 months (5.5–6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall’s τ = 0.613), lower in those subjects who received second-line (Kendall’s τ = 0.539), especially with ramucirumab+CT (Kendall’s τ = 0.413). Conclusion This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.
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Affiliation(s)
| | - Javier Gallego
- Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
- * E-mail:
| | - Raquel Hernandez
- Medical Oncology Department, Hospital Universitario de Canarias, Tenerife
| | - Virginia Arrazubi
- Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Ana Custodio
- Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain
| | - Juana María Cano
- Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Gema Aguado
- Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
| | - Ismael Macias
- Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
| | - Carlos Lopez
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Flora López
- Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Laura Visa
- Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
| | - Marcelo Garrido
- Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile
| | - Nieves Martínez Lago
- Medical Oncology Department, Complejo Hospitalario Universitario de A Coruña, Coruña, Spain
| | | | - María Luisa Limón
- Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Aitor Azkárate
- Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
| | - Paola Pimentel
- Medical Oncology Department, Hospital Santa Lucía, Cartagena, Spain
| | - Pablo Reguera
- Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Avinash Ramchandani
- Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | - Juan Diego Cacho
- Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | | | - Mónica Granja
- Medical Oncology Department, Hospital Universitario Clínico San Carlos Madrid, Spain
| | - Marta Martín Richard
- Medical Oncology Department, Hospital Universitario Santa Creu i Sant Pau, Barcelona, Spain
| | - Carolina Hernández Pérez
- Medical Oncology Department, Hospital Universitario Nuestra Señora de la Candelaria, Tenerife, Spain
| | - Alicia Hurtado
- Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - Olbia Serra
- Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
| | - Elvira Buxo
- Medical Oncology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Rosario Vidal Tocino
- Medical Oncology Department, Complejo Asistencial Universitario de Salamanca, IBSAL, Salamanca, Spain
| | - Paula Jimenez-Fonseca
- Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain
| | - Alberto Carmona-Bayonas
- Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
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15
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Shah MA, Enzinger P, Ko AH, Ocean AJ, Philip PA, Thakkar PV, Cleveland K, Lu Y, Kortmansky J, Christos PJ, Zhang C, Kaur N, Elmonshed D, Galletti G, Sarkar S, Bhinder B, Pittman ME, Plotnikova OM, Kotlov N, Frenkel F, Bagaev A, Elemento O, Betel D, Giannakakou P, Lenz HJ. Multicenter Phase II Study of Cabazitaxel in Advanced Gastroesophageal Cancer: Association of HER2 Expression and M2-Like Tumor-Associated Macrophages with Patient Outcome. Clin Cancer Res 2020; 26:4756-4766. [PMID: 32641434 DOI: 10.1158/1078-0432.ccr-19-3920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 03/31/2020] [Accepted: 07/01/2020] [Indexed: 12/14/2022]
Abstract
PURPOSE We examined cabazitaxel, a novel next-generation taxoid, in patients with metastatic gastric cancer in a multicenter phase II study. PATIENTS AND METHODS Patients who have progressed on one or more prior therapies for locally advanced, unresectable, or metastatic disease were eligible, and prior taxane therapy was allowed. Taxane-naïve and pretreated cohorts were analyzed independently for efficacy. The primary endpoint for both cohorts was progression-free survival (PFS) using RECIST 1.1, using a Simon's two-stage design (10% significance and 80% power) for both cohorts. Comprehensive molecular annotation included whole exome and bulk RNA sequencing. RESULTS Fifty-three patients enrolled in the taxane-naïve cohort (Arm A) and 23 patients in the prior-taxane cohort (Arm B), from January 8, 2013, to April 8, 2015: median age 61.7 years (range, 35.5-91.8 years), 66% male, 66% Caucasian. The most common adverse events included neutropenia (17% Arm A and 39% Arm B), fatigue/muscle weakness (13%), and hematuria (12%). In Arm A, the 3-month PFS rate was 28% [95% confidence interval (CI), 17%-42%] and did not meet the prespecified efficacy target. The 3-month PFS rate in Arm B was 35% (95% CI, 16%-57%) and surpassed its efficacy target. HER2 amplification or overexpression was associated with improved disease control (P = 0.003), PFS (P = 0.04), and overall survival (P = 0.002). An M2 macrophage signature was also associated with improved survival (P = 0.031). CONCLUSIONS Cabazitaxel has modest activity in advanced gastric cancer, including in patients previously treated with taxanes. Her2 amplification/overexpression and M2 high macrophage signature are potential biomarkers for taxane efficacy that warrant further evaluation.
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Affiliation(s)
- Manish A Shah
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York. .,Englander Institute of Precision Medicine, Meyer Cancer Center, New York, New York
| | - Peter Enzinger
- Dana-Farber Cancer Center, Medical Oncology, Boston, Massachusetts
| | - Andrew H Ko
- University of California San Francisco, Medical Oncology, San Francisco, California
| | - Allyson J Ocean
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Philip Agop Philip
- Department of Medical Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, Michigan
| | - Prashant V Thakkar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Kyle Cleveland
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Yao Lu
- Division of Biostatistics and Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Jeremy Kortmansky
- Yale Cancer Center, Division of Medical Oncology and Hematology, New Haven, Connecticut
| | - Paul J Christos
- Division of Biostatistics and Epidemiology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Chao Zhang
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Navjot Kaur
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Dina Elmonshed
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Giuseppe Galletti
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Sandipto Sarkar
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Bhavneet Bhinder
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Englander Institute of Precision Medicine, Meyer Cancer Center, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Meredith E Pittman
- Department of Anatomic and Clinical Pathology, Weill Cornell, New York, New York
| | | | | | | | | | - Olivier Elemento
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Doron Betel
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York.,Institute for Computational Biomedicine, Weill Cornell Medicine, New York, New York
| | - Paraskevi Giannakakou
- Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Heinz-Josef Lenz
- University of Southern California, Norris Cancer Center, Medical Oncology, Los Angeles, California
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16
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Merz V, Zecchetto C, Simionato F, Cavaliere A, Casalino S, Pavarana M, Giacopuzzi S, Bencivenga M, Tomezzoli A, Santoro R, Fedele V, Contarelli S, Rossi I, Giacomazzi S, Pasquato M, Piazzola C, Milleri S, de Manzoni G, Melisi D. A phase II trial of the FGFR inhibitor pemigatinib in patients with metastatic esophageal-gastric junction/gastric cancer trastuzumab resistant: the FiGhTeR trial. Ther Adv Med Oncol 2020; 12:1758835920937889. [PMID: 32684989 PMCID: PMC7346700 DOI: 10.1177/1758835920937889] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Prognosis of patients affected by metastatic esophageal–gastric junction (EGJ) or gastric cancer (GC) remains dismal. Trastuzumab, an anti-HER2 monoclonal antibody, is the only targeted agent approved for the first-line treatment of patients with HER2-overexpressing advanced EGJ or GC in combination with chemotherapy. However, patients invariably become resistant during this treatment. We recently identified the overexpression of fibroblast growth factor (FGF) receptor 3 (FGFR3) as a molecular mechanism responsible for trastuzumab resistance in GC models, providing the rationale for the inhibition of this receptor as a potential second-line strategy in this disease. Pemigatinib is a selective, potent, oral inhibitor of FGFR1, 2, and 3. Methods: The FiGhTeR trial is a phase II, single-arm, open-label study to assess safety and activity of the FGFR inhibitor pemigatinib as second-line treatment strategy in metastatic EGJ/GC patients progressing under trastuzumab-containing therapies. The primary endpoint is the 12-week progression-free survival rate. Plasma and tumor tissue samples will be collected for translational research analyses at baseline, during treatment, and at progression on pemigatinib. Discussion: Co-alterations in genes coding for different tyrosine-kinase receptors are emerging as relevant mechanisms of acquired resistance to anti-HER2 therapeutic strategies in GC. In particular, our group has recently identified that in GC models the overexpression of FGFR3 sustains the acquired resistance to trastuzumab. This trial aims to assess the safety, tolerability and activity of the FGFR inhibitor pemigatinib as a second-line treatment in metastatic EGJ/GC patients refractory to first-line trastuzumab-containing therapies. Furthermore, this study offers the opportunity to prospectively study mechanisms and pathways involved in trastuzumab resistance. Protocol number: CRC2017_02 EudraCT Number: 2017-004522-14
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Affiliation(s)
- Valeria Merz
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Camilla Zecchetto
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Francesca Simionato
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Alessandro Cavaliere
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Simona Casalino
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Michele Pavarana
- Medical Oncology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Simone Giacopuzzi
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Maria Bencivenga
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Anna Tomezzoli
- Anatomical Pathology Unit, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Raffaela Santoro
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Vita Fedele
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Serena Contarelli
- Digestive Molecular Clinical Oncology Research Unit, Department of Medicine, Università degli studi di Verona, Verona, Italy
| | - Irene Rossi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Serena Giacomazzi
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Martina Pasquato
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Cristiana Piazzola
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Stefano Milleri
- Centro Ricerche Cliniche di Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Giovanni de Manzoni
- Esophageal and Gastric Surgery Unit, Department of Surgery, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - Davide Melisi
- Digestive Molecular Clinical Oncology unit, Section of Medical Oncology, Department of Medicine, University of Verona, AOUI Verona - Policlinico "G.B. Rossi", Piazzale L.A. Scuro,10, Verona, 37134, Italy
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17
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Iwasa S, Kudo T, Takahari D, Hara H, Kato K, Satoh T. Practical guidance for the evaluation of disease progression and the decision to change treatment in patients with advanced gastric cancer receiving chemotherapy. Int J Clin Oncol 2020; 25:1223-1232. [PMID: 32347434 PMCID: PMC7329754 DOI: 10.1007/s10147-020-01684-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 04/16/2020] [Indexed: 02/08/2023]
Abstract
After failure of first-line chemotherapy with fluoropyrimidines and platinum compounds for advanced gastric cancer, second-line chemotherapy with ramucirumab plus paclitaxel, which elicits a durable response, and third-line or later chemotherapy with nivolumab have been shown to lead to a more favorable prognosis in advanced gastric cancer patients. As new and more effective drugs are now available, sequential chemotherapy would contribute to prolonged survival. From this point of view, the patient's disease course should be frequently monitored in order to adapt treatment regimens. This review summarizes the points to note in regard to radiological assessment, and discusses the integration of prognostic factors, tumor markers, and clinical symptoms that need to be taken into account to change treatment at an appropriate timing.
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Affiliation(s)
- Satoru Iwasa
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Toshihiro Kudo
- Department of Medical Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Daisuke Takahari
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, 5-1-1, Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Taroh Satoh
- Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
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18
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Wang J, Yang B, Li Z, Qu J, Liu J, Song N, Chen Y, Cheng Y, Zhang S, Wang Z, Qu X, Liu Y. Nomogram-based prediction of survival in unresectable or metastatic gastric cancer patients with good performance status who received first-line chemotherapy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:311. [PMID: 32355755 PMCID: PMC7186730 DOI: 10.21037/atm.2020.02.131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Background Good performance status (PS) is widely acknowledged to have a high prognostic ability, although the prognostic parameters of cancer patients with good PS are still uncertain. This study was conducted to establish and validate a point-based nomogram to assist with predicting prognosis in unresectable or metastatic gastric cancer (GC) patients who had good PS and underwent first-line chemotherapy. Methods At random, a total of 309 patients with GC were split into 2 cohorts: a training cohort (n=259) and an internal validation cohort (n=50). An independent external validation cohort comprising 147 patients was also recruited. Both univariate and multivariate Cox regression analyses were used to evaluate patients based on the overall survival (OS) to develop the nomogram, which was subsequently validated using the concordance index (c-index), calibration curve, and decision curve analysis (DCA). Results The nomogram contained 3 independent prognostic variables in the training cohort: the number of distant metastatic sites (P<0.001), carbohydrate antigen 199 (CA199) level (P=0.002), and fibrinogen (P=0.020). The nomogram predicted an OS with a c-index of 0.623 (95% CI, 0.58–0.67) in the training cohort. The internal validation showed that the nomogram had a c-index of 0.614 (95% CI, 0.51–0.72). For external validation, the c-index was 0.638 (95% CI, 0.58–0.70). Conclusions A reliable point-based nomogram for predicting the prognosis of patients who had unresectable or metastatic GC and good PS who underwent first-line chemotherapy was developed and validated. Keywords Nomogram-based prediction; overall survival; unresectable gastric cancer; metastatic gastric cancer; good performance status; first-line chemotherapy
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Affiliation(s)
- Jin Wang
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Bowen Yang
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Zhi Li
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Jinglei Qu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Jing Liu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Na Song
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Ying Chen
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Yu Cheng
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Simeng Zhang
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Zhongqing Wang
- Department of Information Center, the First Hospital of China Medical University, Shenyang 110001, China
| | - Xiujuan Qu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
| | - Yunpeng Liu
- Department of Medical Oncology, the First Hospital of China Medical University, Shenyang 110001, China.,Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, the First Hospital of China Medical University, Shenyang 110001, China
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19
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Feng R, Li J, Sah BK, Yuan F, Jin X, Yan M, Liu B, Li C, Zhu Z. Overexpression of CrkL as a novel biomarker for poor prognosis in gastric cancer. Cancer Biomark 2020; 26:131-138. [PMID: 31356198 DOI: 10.3233/cbm-192435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The signaling adapter protein CrkL plays vital roles in multiple cancers. However, the expression pattern of CrkL protein and its clinical significance have not been well characterized in human gastric cancer (GC) so far. OBJECTIVE To investigate the association of tissue-based CrkL protein expression level with the clinicopathological characteristics and prognosis of GC patients. METHODS The expression level of CrkL protein in 380 GC patients was analyzed by immunohistochemistry. The associations of CrkL protein expression level with clinicopathologicalal characteristics and clinical outcome were evaluated. RESULTS Compared with the matched adjacent non-tumor tissues, CrkL protein expression level was significantly up-regulated in tumor tissues. In addition, there was a positive correlation between CrkL and Ki67 expression levels in GC patients. An elevated CrkL level statistically correlated with aggressive clinicopathologicalal characteristics, such as larger tumor size, deeper local invasion, more lymph node metastasis, advanced TNM stage, and poorer prognosis. Notably, multivariate analysis identified tissue-based CrkL level as an independent predictor for the unfavorable prognosis of GC. CONCLUSIONS These results indicate that CrkL protein may serve as a novel prognostic biomarker in GC.
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Affiliation(s)
- Runhua Feng
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jianfang Li
- Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Birendra K Sah
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Fei Yuan
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiaolong Jin
- Department of Pathology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Min Yan
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bingya Liu
- Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chen Li
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhenggang Zhu
- Department of General Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Gastric Neoplasms, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Institute of Digestive Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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20
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Rizzo A, Mollica V, Ricci AD, Maggio I, Massucci M, Rojas Limpe FL, Fabio FD, Ardizzoni A. Third- and later-line treatment in advanced or metastatic gastric cancer: a systematic review and meta-analysis. Future Oncol 2019; 16:4409-4418. [PMID: 31793342 DOI: 10.2217/fon-2019-0429] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Aim: We performed a systematic review and meta-analysis to investigate the efficacy and safety of third-line (TLT) and salvage treatment (ST) in advanced or metastatic gastric cancer. Materials & methods: Eligible studies included randomized clinical trials assessing TLT and ST versus placebo or best supportive care. Outcomes of interest included: overall survival, objective response rate and disease control rate in TLT; progression-free survival in ST; grade 3-4 adverse events in ST. Results: The use of TLT and ST was superior to placebo or best supportive care in terms of prolonging overall survival and progression-free survival. Hematological toxicities were more frequent in ST. Conclusion: TLT and ST are considerable and tolerable treatment options for patients with advanced or metastatic gastric cancer. Given the substantial heterogeneities affecting the efficacy analyses, these results have to be interpreted cautiously.
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Affiliation(s)
- Alessandro Rizzo
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Veronica Mollica
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Angela Dalia Ricci
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Ilaria Maggio
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Massucci
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | | | - Francesca Di Fabio
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andrea Ardizzoni
- Division of Medical Oncology, S Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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21
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Salati M, Orsi G, Smyth E, Aprile G, Beretta G, De Vita F, Di Bartolomeo M, Fanotto V, Lonardi S, Morano F, Pietrantonio F, Pinto C, Rimassa L, Vasile E, Vivaldi C, Zaniboni A, Ziranu P, Cascinu S. Gastric cancer: Translating novels concepts into clinical practice. Cancer Treat Rev 2019; 79:101889. [PMID: 31445415 DOI: 10.1016/j.ctrv.2019.101889] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/10/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
The overall 5-year survival of gastric cancer (GC) has change only little in the last decades and it remains the fifth leading cause of cancer-related death worldwide. However, in the past few years a more effective combination chemotherapy has raised the bar of curability of about 10% in resectable disease. Morever, a deeper knowledge of GC biology have unveiled biomarkers to help personalize adjunctive treatments in patients candidate to surgery. Despite a plateau in efficacy of fist-line treatment, incremental survival advantages have been recorded in unresectable advanced disease. The growing number of effective drugs in second and later lines along with a more judicious delivery of cytotoxics and early supportive interventions have enabled more patients to proceed beyond first-line. The continuum of care has become a reality in a considerable proportion of patients that offer opportunities to improve outcomes. Finally, the advent of the immune checkpoint inhibitors has brought great expectations in molecularly-defined subset of patients. This Review summarizes the state-of-the art in the management of GC together with novel concepts that have entered clinical development with the potential of change practice in the foreseeable future.
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Affiliation(s)
- Massimiliano Salati
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy.
| | - Giulia Orsi
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
| | - Elisabeth Smyth
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 0QQ, UK
| | | | | | - Fernando De Vita
- Oncologia Medica- Dipartimento di Medicina di Precisione, Università della Campania "Luigi Vanvitelli", Napoli, Italy
| | - Maria Di Bartolomeo
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Valentina Fanotto
- Department of Medicine (DAME), University of Udine, Piazzale Kolbe, 4 - 33100 Udine, Italy
| | - Sara Lonardi
- SSD Sperimentazioni Cliniche di Fase Precoce, Dipartimento di Oncologia, Istituto Oncologico Veneto, IRCCS via Gattamelata, 64 35128 Padova, Italy
| | - Federica Morano
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Filippo Pietrantonio
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Oncology and Hemato-oncology, University of Milan, Italy
| | - Carmine Pinto
- Medical Oncology, AUSL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center - IRCCS, Via Manzoni 56, 20089 Rozzano, Milan, Italy
| | - Enrico Vasile
- Oncologia, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Caterina Vivaldi
- Department of Translational Research and of New Surgical and Medical Technologies, University of Pisa, Pisa, Italy
| | | | - Pina Ziranu
- Department of Medical Oncology, University of Cagliari, Cagliari, Italy
| | - Stefano Cascinu
- Department of Medical Oncology, Universita' di Modena e Reggio Emilia, Modena, Italy
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22
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Casadei-Gardini A, Scarpi E, Ulivi P, Palladino MA, Accettura C, Bernardini I, Spallanzani A, Gelsomino F, Corbelli J, Marisi G, Ruscelli S, Valgiusti M, Frassineti GL, Passardi A. Prognostic role of a new inflammatory index with neutrophil-to-lymphocyte ratio and lactate dehydrogenase (CII: Colon Inflammatory Index) in patients with metastatic colorectal cancer: results from the randomized Italian Trial in Advanced Colorectal Cancer (ITACa) study. Cancer Manag Res 2019; 11:4357-4369. [PMID: 31191000 PMCID: PMC6522652 DOI: 10.2147/cmar.s198651] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 02/27/2019] [Indexed: 12/25/2022] Open
Abstract
Aim: The aim of this study was to investigate the role of a new inflammatory index (Colon Inflammatory Index [CII]) as a predictor of prognosis and treatment efficacy in patients with metastatic colorectal cancer (mCRC) enrolled in the prospective multicenter randomized ITACa (Italian Trial in Advanced Colorectal Cancer) trial to receive first-line chemotherapy (CT)+ bevacizumab or CT alone. Patients and methods: Between November 14, 2007 and March 6, 2012, 276 patients diagnosed with CRC were available for baseline neutrophil-to-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH). We divided the population into three groups on basis of the CII index. Results: At baseline in all populations, median PFS and OS was predictive of clinical outcome (p<0.0001). Following adjustment for clinical covariates, multivariate analysis confirmed CII index as an independent prognostic factor. The CII index was also predictive when we evaluated the two distinct arms with (p=0.0009) or without bevacizumab (p=0.0001). When we divided right side versus left side for treatment regimen (CT plus bevacizumab versus only bevacizumab), we found a benefit of bevacizumab versus only CT in the right side in patients treated with bevacizumab and not in patients treated with only chemotherapy. Conversely, we found no difference the left side, but we found a difference in the poor group of 4 months in favor to only chemotherapy. Conclusion: Our results indicate that the CII index is a good prognostic marker for mCRC patients in first line treatment with CT with or without bevacizumab. Trial registration: NCT01878422 ClinicalTrials.gov; date of registration: June 7, 2013.
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Affiliation(s)
- Andrea Casadei-Gardini
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Emanuela Scarpi
- Unit of Biostatistics and Clinical Trials, IRST IRCCS, Meldola, Italy
| | - Paola Ulivi
- Biosciences Laboratory, IRST IRCCS, Meldola, Italy
| | | | | | | | - Andrea Spallanzani
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, Modena, Italy
| | - Fabio Gelsomino
- Department of Oncology and Hematology, Division of Oncology, University Hospital Modena, Modena, Italy
| | | | | | - Silvia Ruscelli
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Martina Valgiusti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Giovanni Luca Frassineti
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
| | - Alessandro Passardi
- Department of Medical Oncology, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola, Italy
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23
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Touchefeu Y, Guimbaud R, Louvet C, Dahan L, Samalin E, Barbier E, Le Malicot K, Cohen R, Gornet JM, Aparicio T, Nguyen S, Azzedine A, Etienne PL, Phelip JM, Hammel P, Chapelle N, Sefrioui D, Mineur L, Lepage C, Bouche O. Prognostic factors in patients treated with second-line chemotherapy for advanced gastric cancer: results from the randomized prospective phase III FFCD-0307 trial. Gastric Cancer 2019; 22:577-586. [PMID: 30311042 DOI: 10.1007/s10120-018-0885-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 10/01/2018] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to determine prognostic factors in patients treated with second-line therapy (L2) for locally advanced or metastatic gastric and gastro-esophageal junction (GEJ) adenocarcinoma in a randomized phase III study with predefined L2. METHODS In the FFCD-0307 study, patients were randomly assigned to receive in L1 either epirubicin, cisplatin, and capecitabine (ECX arm) or fluorouracil, leucovorin, and irinotecan (FOLFIRI arm). L2 treatment was predefined (FOLFIRI for the ECX arm and ECX for the FOLFIRI arm). Chi square tests were used to compare the characteristics of patients treated in L2 with those of patients who did not receive L2. Prognostic factors in L2 for progression-free survival (PFS) and overall survival (OS) were analyzed using a Cox model. RESULTS Among 416 patients included, 101/209 (48.3%) patients in the ECX arm received FOLFIRI in L2, and 81/207 (39.1%) patients in the FOLFIRI arm received ECX in L2. Patients treated in L2, compared with those who only received L1 had : a better ECOG score (0-1: 90.4% versus 79.7%; p = 0.0002), more frequent GEJ localization (40.8% versus 27.6%; p = 0.005), and lower platelet count (median: 298000 versus 335000/mm3; p = 0.02). In multivariate analyses, age < 60 years at diagnosis (HR 1.49, 95% CI 1.09-2.03, p = 0.013) and ECOG score 2 before L2 (HR 2.62, 95% CI 1.41-4.84, p = 0.005) were the only significant poor prognostic factors for OS. CONCLUSION Age ≥ 60 years at diagnosis and ECOG score 0/1 before L2 were the only favorable prognostic factors for OS.
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Affiliation(s)
- Y Touchefeu
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France.
| | - R Guimbaud
- Digestive Medical Oncology IUCT Rangueil, CHU de Toulouse, Toulouse, France
| | - C Louvet
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - L Dahan
- Digestive Oncology Unit, AP-HM, La Timone Hospital, Aix-Marseille Université, Marseille, France
| | - E Samalin
- Digestive Oncology Department, Institut du Cancer de Montpellier, Montpellier, France
| | - E Barbier
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - K Le Malicot
- Fédération Francophone de Cancérologie Digestive-EPICAD INSERM LNC-UMR 1231, University of Burgundy and Franche Comté, Dijon, France
| | - R Cohen
- Department of Oncology, Sorbonne Université, AP-HP, hôpital Saint-Antoine, 75012, Paris, France
| | - J M Gornet
- Department of Gastroenterology, AP-HP Hôpital Saint Louis, Paris, France
| | - T Aparicio
- Department of Gastroenterology and Digestive Oncology, Saint Louis Hospital, APHP, University Denis Diderot, Sorbonne Paris Cité, Paris, France
| | - S Nguyen
- Oncology Multidisciplinary Research Group (GERCOR), 151 rue du Faubourg Saint Antoine, 75011, Paris, France
| | - A Azzedine
- Department of oncology, CH Montélimar, Montélimar, France
| | - P L Etienne
- Oncology Department, CARIO, HPCA, Plérin, France
| | - J M Phelip
- Service HGE et Oncologie Digestive, CHU de Saint Etienne, Unité HESPER EA-7425 Université Jean Monnet/Claude Bernard Lyon 1, Villeurbanne, France
| | - P Hammel
- Digestive Oncology Unit, Beaujon Hospital, Assistance Publique-Hôpitaux de Paris, Clichy, France
| | - N Chapelle
- Gastrointestinal Oncology Unit, Institut des Maladies de l'Appareil Digestif, University Hospital, 1 place Alexis Ricordeau, 44093, Nantes Cedex 1, France
| | - D Sefrioui
- Digestive Oncology Unit, Department of Hepato-Gastroenterology, Rouen University Hospital, UNIROUEN, Inserm U1245, IRON group, Normandie University, 76000, Rouen, France
| | - L Mineur
- Institut Sainte Catherine, Avignon, France
| | - C Lepage
- Gastroenterology Department, INSERM UMR1231, CHU de Dijon, University Bourgogne Franche-Comté, Dijon, France
| | - O Bouche
- Digestive Oncology, CHU REIMS, Reims, France
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24
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Fanotto V, Fornaro L, Bordonaro R, Rosati G, Rimassa L, Di Donato S, Santini D, Tomasello G, Leone F, Silvestris N, Stragliotto S, Scartozzi M, Giampieri R, Nichetti F, Antonuzzo L, Cinieri S, Avallone A, Pellegrino A, Melisi D, Vasile E, Gerratana L, Aprile G. Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study. J Geriatr Oncol 2018; 10:591-597. [PMID: 30551958 DOI: 10.1016/j.jgo.2018.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 11/04/2018] [Accepted: 11/28/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVES Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. MATERIALS AND METHODS Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. RESULTS Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P = .02). Poorly differentiated tumours were more often observed in non-older patients (P = .009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P = .02), while peritoneal spread was more represented in non-older patients (P = .002). Although older patients were more often treated with monotherapy (P = .001), they had similar PFS (HR 0.86, 95%CI 0.71-1.03, P = .102) and OS (HR 0.82, 95%CI 0.65-1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. CONCLUSION In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Lorenzo Fornaro
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | | | | | - Lorenza Rimassa
- Medical Oncology and Hematology Unit, Humanitas Cancer Center, Humanitas Clinical and Research Center-IRCCS, Rozzano(MI), Italy
| | | | | | | | - Francesco Leone
- Medical Oncology, University of Turin, Candiolo Cancer Institute, FPO, IRCCS, Turin, Italy
| | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | - Silvia Stragliotto
- UOC Oncologia Medica 1, Dip. di Oncologia, Istituto Oncologico Veneto - IRCCS, Padova, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Federico Nichetti
- Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
| | | | | | - Antonio Avallone
- Experimental Abdomen Medical Oncology, Istituto Nazionale Tumori - IRCCS - Fondazione G. Pascale, Napoli, Italy
| | | | | | - Enrico Vasile
- Unit of Oncology 2, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy; Department of Oncology, San Bortolo General Hospital, ULSS8 Berica - East District, Vicenza, Italy.
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25
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Koukourakis MI, Giatromanolaki A. Warburg effect, lactate dehydrogenase, and radio/chemo-therapy efficacy. Int J Radiat Biol 2018; 95:408-426. [PMID: 29913092 DOI: 10.1080/09553002.2018.1490041] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The anaerobic metabolism of glucose by cancer cells, even under well-oxygenated conditions, has been documented by Otto Warburg as early as 1927. Micro-environmental hypoxia and intracellular pathways activating the hypoxia-related gene response, shift cancer cell metabolism to anaerobic pathways. In the current review, we focus on a major enzyme involved in anaerobic transformation of pyruvate to lactate, namely lactate dehydrogenase 5 (LDH5). The value of LDH5 as a marker of prognosis of cancer patients, as a predictor of response to radiotherapy (RT) and chemotherapy and, finally, as a major target for cancer treatment and radio-sensitization is reported and discussed. Clinical, translational and experimental data supporting the uniqueness of the LDHA gene and its product LDH5 isoenzyme are summarized and future directions for a metabolic treatment of cancer are highlighted.
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Affiliation(s)
- Michael I Koukourakis
- a Department of Radiotherapy and Oncology, Medical School, Democritus University of Thrace , Alexandroupolis , Greece
| | - Alexandra Giatromanolaki
- b Department of Pathology , Medical School, Democritus University of Thrace , Alexandroupolis , Greece
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Ogata T, Satake H, Ogata M, Hatachi Y, Inoue K, Hamada M, Yasui H. Neutrophil-to-lymphocyte ratio as a predictive or prognostic factor for gastric cancer treated with nivolumab: a multicenter retrospective study. Oncotarget 2018; 9:34520-34527. [PMID: 30349646 PMCID: PMC6195378 DOI: 10.18632/oncotarget.26145] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 09/08/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction The neutrophil-to-lymphocyte ratio (NLR) is effective as a predictive factor for lung cancer treated with nivolumab. The objective of this study was to determine the effectiveness of NLR for patients with advanced gastric cancer (AGC) treated with nivolumab. Methods This was a multicenter, retrospective study of patients with AGC treated with nivolumab from June 2017 to December 2017. The NLRs were calculated before the first cycle (NLRpre) and two weeks after the first administration (NLRpost). Results Twenty-six patients were enrolled (males 19, females 7) with a median age of 64 years. The overall response rate was 15%. The median PFS was 80 days (range, 11 – 265) and the median OS was 290 days (range, 21 – 332). Stratified with high NLR (≥5) and low NLR (<5), the median PFS was shorter in the high NLRpre arm (87 vs. 45 days; p=0.066) and significantly shorter in the high NLRpost arm (94 vs. 28 days; p=0.014). The median OS was significantly shorter in the high NLRpre arm (290 vs. 175 days; p=0.008) and in the high NLRpost arm (290 vs. 69 days; p<0.001). Conclusion NLR may be an effective prognostic factor in patients with AGC treated with nivolumab.
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Affiliation(s)
- Takatsugu Ogata
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Hironaga Satake
- Cancer Treatment Center, Kansai Medical University Hospital, Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Misato Ogata
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Yukimasa Hatachi
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
| | - Kentaro Inoue
- Department of Surgery, Kansai Medical University Hospital, Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Madoka Hamada
- Department of Surgery, Kansai Medical University Hospital, Shinmachi, Hirakata City, Osaka, 573-1191, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Chuo-ku, Kobe City, Hyogo, 650-0047, Japan
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Fanotto V, Uccello M, Pecora I, Rimassa L, Leone F, Rosati G, Santini D, Giampieri R, Di Donato S, Tomasello G, Silvestris N, Pietrantonio F, Battaglin F, Avallone A, Scartozzi M, Lutrino ES, Melisi D, Antonuzzo L, Pellegrino A, Ferrari L, Bordonaro R, Vivaldi C, Gerratana L, Bozzarelli S, Filippi R, Bilancia D, Russano M, Aprile G. Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy. Oncologist 2017; 22:1463-1469. [PMID: 28860412 DOI: 10.1634/theoncologist.2017-0158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2017] [Accepted: 07/14/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Second-line therapy has consistently demonstrated survival benefit if compared with best supportive care; however, there is limited evidence whether further lines of treatment may improve the prognosis of advanced gastric cancer (AGC) patients. MATERIALS AND METHODS Starting from a real-world cohort of 868 AGC patients, we retrospectively analyzed baseline parameters, tumor characteristics, and treatment data of those treated with at least three lines. Categorical features were described through cross-tables and chi-square test. We explored the impact of treatment intensity and progression-free survival (PFS) experienced in previous lines on PFS and overall survival in third-line by uni- and multivariate Cox regression models and described by Kaplan-Meier estimator plot with log-rank test. RESULTS Overall, 300 patients were included in the analysis. The most common site of primary tumor was gastric body; 45.3% of cancers had an intestinal histotype, 14% were human epidermal growth receptor 2 positive. In third-line, 45.7% of patients received a single-agent chemotherapy, 49.7% a combination regimen. Patients who had experienced a first-line PFS ≥6.9 months had a better prognosis compared with those who had achieved a shorter one. Consistently, a second-line PFS ≥3.5 months positively influenced the prognosis. Patients receiving a third-line combination regimen had better outcomes compared with those treated with a single-agent chemotherapy. CONCLUSION Our real-world study confirms that selected AGC patients may receive third-line treatment. Longer PFS in previous lines or a more intense third-line treatment positively influenced prognosis. Further efforts are warranted to define the best therapeutic sequences, and to identify the optimal candidate for treatment beyond second-line. IMPLICATIONS FOR PRACTICE The benefit of third-line treatment to advanced gastric cancer patients is controversial. This study depicts a real scenario of the clinical practice in Italy, confirming that a non-negligible proportion of patients receive a third-line therapy. Longer progression-free survival in previous treatment lines or higher third-line treatment intensity positively influenced prognosis. Including a large number of real-world patients, this study provides information on third-line treatment from the daily clinical practice; moreover, its results help in defining the best therapeutic sequence and offer some hints to select the optimal candidate for treatment beyond second-line.
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Affiliation(s)
- Valentina Fanotto
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Mario Uccello
- Department of Oncology, Garibaldi Nesima Hospital, Catania, Italy
| | - Irene Pecora
- Department of Oncology, University Hospital, Pisa, Italy
| | - Lorenza Rimassa
- UO Oncologia Medica, Humanitas Cancer Center, Humanitas Research Hospital-IRCCS, Rozzano, (MI), Italy
| | - Francesco Leone
- Institute for Cancer Research and Treatment, IRCCS Candiolo (TO), Italy
| | | | | | | | | | | | - Nicola Silvestris
- Medical Oncology Unit, National Cancer Institute IRCCS "Giovanni Paolo II", Bari, Italy
| | | | | | - Antonio Avallone
- Abdomen Medical Oncology, Istituto Nazionale Tumori-IRCCS-Fondazione G. Pascale, Napoli, Italy
| | - Mario Scartozzi
- Medical Oncology, University of Cagliari, University Hospital, Cagliari, Italy
| | | | - Davide Melisi
- Medical Oncology, University of Verona, Verona, Italy
| | | | | | - Laura Ferrari
- Department of Oncology, University and General Hospital, Udine, Italy
| | | | | | - Lorenzo Gerratana
- Department of Oncology, University and General Hospital, Udine, Italy
| | - Silvia Bozzarelli
- UO Oncologia Medica, Humanitas Cancer Center, Humanitas Research Hospital-IRCCS, Rozzano, (MI), Italy
| | - Roberto Filippi
- Institute for Cancer Research and Treatment, IRCCS Candiolo (TO), Italy
| | | | - Marco Russano
- Medical Oncology, Campus Biomedico University, Roma, Italy
| | - Giuseppe Aprile
- Department of Oncology, University and General Hospital, Udine, Italy
- Department of Oncology, San Bortolo General Hospital, ULSS8 Berica-East District, Vicenza, Italy
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Salati M, Di Emidio K, Tarantino V, Cascinu S. Second-line treatments: moving towards an opportunity to improve survival in advanced gastric cancer? ESMO Open 2017; 2:e000206. [PMID: 29209523 PMCID: PMC5703389 DOI: 10.1136/esmoopen-2017-000206] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/04/2017] [Indexed: 12/26/2022] Open
Abstract
Gastric cancer is the third leading cause of cancer-related death globally with approximately 723 000 deaths every year. Most patients present with advanced unresectable or metastatic disease, only amenable to palliative systemic treatment and a median survival uncommonly exceeding 12 months. Over the last years, the efficacy of chemotherapy combination has plateaued and the introduction of the anti-human epidermal growth factor receptor 2 trastuzumab has resulted in a limited survival gain in the upfront setting. After this positive experience, first-line treatment with new targeted therapies failed to improve the outcome of advanced gastric cancer. On the contrary, second-line options, including monochemotherapy with taxanes or irinotecan and the anti-vascular endothelial growth factor receptor 2 ramucirumab, either alone or combined with paclitaxel, opened new therapeutic rooms for an ever-increasing number of patients who maintain an acceptable performance status across multiple lines. This article provides an updated overview on the current management of advanced gastric cancer and discusses how the different treatment options available may be best combined to favourably impact the outcome of patients following the logic of a treatment strategy.
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Affiliation(s)
- Massimiliano Salati
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Katia Di Emidio
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Vittoria Tarantino
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Stefano Cascinu
- Department of Oncology, Università di Modena e Reggio Emilia, Policlinico di Modena, Modena, Italy
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