Optimal duration of first-line chemotherapy for advanced gastric cancer:: data from the AGAMENON registry

• A. Viúdez ^[15] ; A. Carmona-Bayonas ^[16] ; J. Gallego ^[17] ; A. Lacalle ^[18] ; R. Hernández ^[1] ; J. M. Cano ^[2] ; I. Macías ^[19] ; A. Custodio ^[3] ; E. Martínez de Castro ^[4] ; A. Sánchez ^[20] ; L. Iglesia ^[21] ; P. Reguera ^[5] ; L. Visa ^[22] ; A. Azkarate ^[6] ; M. Sánchez-Cánovas ^[23] ; M. Mangas ^[24] ; M. L. Limón ^[7] ; A. Martínez-Torrón ^[8] ; E. Asensio ^[17] ; A. Ramchandani ^[9] ; A. Martín-Carnicero ^[10] ; A. Hurtado ^[11] ; P. Cerdà ^[25] ; M. Garrido ^[12] ; R. Sánchez-Bayonas ^[13] ; R. Serrano ^[14] ; P. Jiménez-Fonseca ^[8]
  1. [1] Hospital Universitario de Canarias

     Hospital Universitario de Canarias

     San Cristóbal de La Laguna, España

     
  2. [2] Hospital General de Ciudad Real

     Hospital General de Ciudad Real

     Ciudad Real, España

     
  3. [3] Hospital Universitario La Paz

     Hospital Universitario La Paz

     Madrid, España

     
  4. [4] Hospital Universitario Marqués de Valdecilla

     Hospital Universitario Marqués de Valdecilla

     Santander, España

     
  5. [5] Hospital Ramón y Cajal

     Hospital Ramón y Cajal

     Madrid, España

     
  6. [6] Hospital Universitario Son Espases

     Hospital Universitario Son Espases

     Palma de Mallorca, España

     
  7. [7] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  8. [8] Hospital Universitario Central de Asturias

     Hospital Universitario Central de Asturias

     Oviedo, España

     
  9. [9] Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias

     Complejo Hospitalario Universitario Insular - Materno Infantil de Canarias

     Gran Canaria, España

     
  10. [10] Hospital San Pedro

      Hospital San Pedro

      Logroño, España

      
  11. [11] Fundación Hospital Alcorcón

      Fundación Hospital Alcorcón

      Alcorcón, España

      
  12. [12] Pontificia Universidad Católica de Chile

      Pontificia Universidad Católica de Chile

      Santiago, Chile

      
  13. [13] Clínica Universitaria de Navarra

      Clínica Universitaria de Navarra

      Pamplona, España

      
  14. [14] Hospital Universitario Reina Sofia

      Hospital Universitario Reina Sofia

      Cordoba, España

      
  15. [15] Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain
  16. [16] Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain
  17. [17] Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain
  18. [18] Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
  19. [19] Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
  20. [20] Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
  21. [21] Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
  22. [22] Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
  23. [23] Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain
  24. [24] Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
  25. [25] Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 22, Nº. 5, 2020, págs. 734-750
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression.

    Method The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted.

    Results 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69–1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%).

    Conclusion The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events