Background There is neither consensus on firstline chemotherapy for advanced gastric cancer (AGC) nor new drugs or schemes approved in recent years.
Purpose To evaluate the evolution in use and effectiveness of firstline polychemotherapy regimens over an 8 year period in AGC.
Material and methods Patients with AGC treated with polychemotherapy were included from 2009 to 2016 in the AGAMENON multicentre observational study to assess prognostic factors and patterns of care. Firstline regimens were grouped into docetaxel or epirubicin containing triplets, fluorouracil plus oxaliplatin, cisplatin or irinotecan doublets, capecitabine plus oxaliplatin or cisplatin doublets and others. According to the year of their first chemotherapy cycle, patients were assigned to one of two groups: the first, from 2009 to 2012, or the second, from 2013 to 2016. Clinical data were obtained from the medical records, after approval by the ethics committee, and introduced into the website of the study. The main clinical variables, progression free survival (PFS) and overall survival (OS), were analysed using the Kaplan–Meier method and compared with a log rank test.
Results The AGAMENON registry contains data from 1252 patients, 448 of whom were treated with a chemotherapy regimen in the first period and 804 in the second. Clinical baseline characteristics of the two populations, 2009–2012 versus 2013–2016, were similar: ECOG performance status ≥2, 16.5 versus 13.7%; men, 66.2% versus 71.7%; median age 65.0 versus 64.0 years; Lauren classification, intestinal 52.2 versus 49.1%; HER-2 overexpression, 18.7 versus 17.9%; and ≥3 metastatic sites, 38.4 versus 31.2%, respectively.
The use of fluorouracil and oxaliplatin increased from 5.4% to 18.3% while capecitabine–cisplatin (22.1 to 12.3) and docetaxel triplets (13.0 to 6.0) use decreased, comparing the first and second periods. Median OS were 10.3 (95% CI 9–11) and 10.8 (10–12) months for patients in the 2009–2012 and 2013–2016 groups, respectively. Median PFS were 6.5 (95% CI 6–7) and 6.7 months (95% CI 6–7) in 2009–2012 and 2013–2016, respectively. These results show that OS and PFS were similar in both groups (log rank p=0.684 and 0.714).
Conclusion Although there were changes in chemotherapy regimens usage, survival remained almost constant over time, pointing to the need for new treatment strategies in AGC.
References and/or acknowledgements The investigators of the AGAMENON study.
No conflict of interest
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