Irinotecan versus best supportive care (BSC) as second-line therapy in gastric cancer: A randomized phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO)

4540

Background: Up to now the value of 2nd-line therapy for metastatic gastric cancer is unclear. So far there are no randomized phase III data comparing 2nd-line chemotherapy to BSC. Irinotecan has proven activity in 1st-line therapy. In this randomized phase III study we compared irinotecan to BSC to evaluate the value of 2nd- line chemotherapy for gastric cancer. Methods: Prospective multicenter randomized phase III study, open label. Eligibility: Metastatic or locally advanced gastro-esophageal junction or gastric adenocarcinoma. Objective tumor progession (PD) within 6 months after 1st- line chemotherapy. ECOG PS 0–2. Statistics: Primary endpoint: Overall survival (OS). Hypothesis: H1: OS(Irinotecan)>OS(BSC). Calculated number of pts needed (power 80%, alpha error 5%): 60 pts per arm. Stratification for a) PD less versus (vs) more than 3 months after 1st line chemotherapy, b) ECOG PS 0/1 vs 2. Treatment: Arm A: Irinotecan 250mg/m2 q3w (1st cycle) to be increased to 350 mg/m2, depending on toxicity. Arm B: BSC Results: Between Oct 2002 and Dec 2006 40 pts were randomized. The study was closed prematurely due to poor accrual. Arm A:21 pts, arm B 19 pts. Median age A: 58 yrs (43–73), B: 55 yrs (35–72); PD less vs more than 3 months after 1st-line chemotherapy: A: 18 / 3, B: 17 / 2pts. ECOG PS 0/1 vs 2: A: 17/ 4, B: 14/ 5pts. Pre-treatment with cisplatin: A: 21, B:19 pts. Arm A: 68 cycles administered in 21 pts. Toxicity: (main CTC grade 3/ 4): Nausea 1 pt, vomiting 1 pt, diarrhoea: 5 pts, neutropenic fever: 2 pts, data incomplete 6 pts. In 37% of 19 evaluable pts irinotecan dose was escalated to 350mg/m2. Response (19 pts evaluable): No objective responses, SD 58%, PD 42%. Improvement of tumor related symptoms: 44% of pts in arm A, 5% in arm B. Survival: (evaluable pts arm A 21, arm B 18): median survival arm A: 123 days (95%CI 95–216), arm B 72.5 days (95%CI 41–106); OS: HR=2.85 (95%CI 1.41–5.79), Logrank test (two-sided): p=0.0027. Conclusions: To our knowledge this is the first randomized phase III study investigating 2nd- line chemotherapy in gastric cancer. Irinotecan as 2nd-line chemotherapy significantly prolongs overall survival compared to BSC. 2nd-line chemotherapy can now be considered as a proven option in gastric cancer.

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Capecitabine and docetaxel for advanced gastric cancer

4068

Background: Docetaxel is increasingly integrated into chemotherapy combination regimens against gastric cancer. Docetaxel and 5-FU were compared to ECF and appeared to be very active and well tolerated (Thuss-Patience et. al. JCO 2005). In the current study the dual combination capecitabine and docetaxel (CapDoc) is evaluated to develop a convenient out-patient regimen with minimal toxicity. Methods: Prospective multicenter phase II trial. Eligibility: Metastatic or locally advanced gastro-esophageal junction or gastric adenocarcinoma, ECOG PS 0–2, no prior palliative chemotherapy. Chemotherapy: Docetaxel 75 mg/m2 d1, capecitabine 2000 mg/m2 d1–14, q3w. For part I of the study (presented here) accrual is completed (40 pts). In part II we reduced the starting dose of docetaxel to 60 mg/m2 and capecitabine to 1600 mg/m2 to further improve tolerability (accrual ongoing, 8 pts included so far, presented at meeting). Results: 40 pts are included in this trial (part I). Age: 32–79 years (median 61), M/F 29/11, ECOG PS 0: 7 pts, 1: 27 pts, 2: 6 pts. Number of organs involved by metastases: 1: 9 pts, 2: 11 pts, 3: 16 pts, more than 3: 4 pts. Measurable disease (RECIST): 40 pts. 233 cycles of chemotherapy are administered so far. Toxicity: 40 pts are evaluable for toxicity (worst grade per patient; % of pts): Grade 1/2/3/4: Nausea: 53/10/3/- %, vomiting: 18/13/-/3 %, diarrhea: 23/20/13/- %, asthenia: 38/40/10/- %, stomatitis: 23/15/10/- %, alopecia: 25/53/-/- %, fever not neutropenic: 10/20/3/- %, neutropenic fever: -/-/10/3 %, nail changes: 33/28/-/- %, paresthesia: 18/18/5/- %, dizziness: 15/8/5/- %, hand-foot-syndrome: 25/18/18/- %, leuko-neutropenia: 8/13/25/28 %, thrombocytopenia: 18/-/-/- %, anemia: 40/15/5/- %, fluid retention: 13/5/-/-, pulmonary embolism or thrombosis: 3/5/3/5. Dose adjustments of docetaxel had to be made in 45% and of capecitabine in 55% of pts. Response: 26 of 37 pts with tumor related symptoms showed a subjective improvement of symptoms (70.3%). 38 pts are evaluable for objective response: CR 1 pt (2.6%), PR 20 pts (52.6%), NC 14 pts (36.8%), PD 3 pts (7.9%), (objective response rate: 55.3%). Median time to tumor progression 5.5 months, median survival 9.5 months. Conclusion: These data suggest that CapDoc is a well tolerated convenient out-patient combination with very promising efficacy.

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