A Retrospective Comparison of Trastuzumab Plus Cisplatin and Trastuzumab Plus Capecitabine in Elderly HER2-Positive Advanced Gastric Cancer Patients

Abstract

A combination of trastuzumab and cisplatin or trastuzumab and capecitabine has been confirmed to be effective for treating adverse effects in with HER2-positive advanced gastric cancer (AGC) patients. We retrospectively compared the activity and safety of trastuzumab plus cisplatin (HP) and trastuzumab plus capecitabine (HX) for elderly HER2-positive AGC patients.Ninety two HER2-positive AGC patients were included in this study; of those 48 patients received trastuzumab (course 1, 8 mg/kg followed by course 2, onward, 6 mg/kg on day 1) plus cisplatin (60 mg/m2) intravenously on day 1 of a 3-week cycle and 44 patients received trastuzumab (course 1, 8 mg/kg; course 2 onward, 6 mg/kg) plus intravenous oral capecitabine (1000 mg/m2 twice daily on days 1–14), every 3 weeks. The primary end point was overall survival (OS). The secondary end points included objective response rate (ORR), progression-free survival (PFS), and toxicity.The median age was 71 years in both groups. The median OS was 15.5 months in the HP group and 17.0 months in the HX group, with no significant difference between the 2 groups (P = 0.78). There were also no significant differences in PFS (median 6.6 months vs 7.2 months, respectively; P = 0.90) and ORR (58.3% vs 59.1%, respectively; P = 1.00) between the HP group and the HX group. The major grade 3 or 4 adverse events in the HP group and the HX group were neutropenia (35.4% vs 29.5%, respectively), followed by anorexia (25.0% vs 22.7%, respectively), and anemia (16.7% vs 13.6%, respectively), no significant differences were observed.HP and HX were associated with similar efficacy and safety in HER2-positive AGC patients.

Comparing cytotoxic backbones for first‐line trastuzumab‐containing regimens in human epidermal growth factor receptor 2‐positive advanced oesophagogastric cancer: A meta‐analysis

“…22,32 The addition of triplet cytotoxic backbones to trastuzumab consisting of docetaxel, platinum and fluoropyrimidine did not increase survival over ToGA, as did regimens in which trastuzumab was combined with another targeted agent bevacizumab plus a cytotoxic triplet backbone. However, the fact that older and frailer patients were included in two of these singlet backbone studies is a plausible explanation for these findings, and the results should therefore be interpreted with caution.…”

“…However, the fact that older and frailer patients were included in two of these singlet backbone studies is a plausible explanation for these findings, and the results should therefore be interpreted with caution. 22,32 The addition of triplet cytotoxic backbones to trastuzumab consisting of docetaxel, platinum and fluoropyrimidine did not increase survival over ToGA, as did regimens in which trastuzumab was combined with another targeted agent bevacizumab plus a cytotoxic triplet backbone. This implicates that there is currently no role for triplet cytotoxic backbones and for bevacizumab in the first-line trastuzumab-based regimen.…”

“…In total, 15 studies containing 557 patients were included, investigating nine alternative backbone regimens ( Table 1). [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] The ToGA trial included 228 patients in the trastuzumab plus cisplatin and capecitabine/5-FU arm. In the doublet and triplet backbone studies, no major differences in patient population were observed compared to the ToGA population (Table 1).…”

Preoperative neoadjuvant chemotherapy on surgical condition and oncogene expression in advanced gastric cancer

“…It has long been considered as the cornerstone of chemotherapy for digestive tract tumours. 13,14 Oxaliplatin as a third-generation platinum chemotherapeutic drug combined with fluorouracil's has been found being significantly effective in improving the chemotherapeutic efficacy of advanced gastric cancer. 15,16 Tian's study found that pre-operative XELOX regimen combined with chemotherapy could improve the radical resection rate of gastric cancer and reduce the clinical stage of cancer to improve the long-term prognosis of patients, 17 which is consistent with the results of this study.…”

Clinical significance of expression of proliferating cell nuclear antigen and E-cadherin in gastric carcinoma

“…Gastric cancer is a common digestive system malignancy that progresses rapidly[ 1 - 3 ]. Its occurrence and development are a very complex process that involves the dysregulation of a variety of oncogenes and tumor suppressor genes[ 4 - 7 ]. At present, an increasing number of scholars have focused their attention on exploring protein and gene markers, in order to help clinicians early and accurately diagnose gastric cancer and assess its prognosis.…”