Clinical Impact of Oral Intake in Second-line or Third-line Chemotherapy for 589 Patients With Advanced Gastric Cancer

Abstract

Objectives: Insufficient oral intake in advanced gastric cancer (AGC) limits the use of several drugs. We aimed to determine the oral intake status of patients with AGC during later-line chemotherapy. Materials and Methods:We retrospectively evaluated data of patients with AGC who experienced disease progression during first-line chemotherapy administered from January 2012 to December 2018 in a single institution. We defined "insufficient oral intake" as requiring daily intravenous fluids or hyperalimentation. Multivariate logistic regression was performed to identify oral intake-related factors.Results: Among 589 included patients, at disease progression during firstline, second-line, and third-line chemotherapy, 78.3% (461), 53.3% (314), and 30.4% (179) of patients, respectively, exhibited sufficient oral intake. Fourth-line chemotherapy was initiated for 22.2% (131) of patients, with 20.0% (118) exhibiting sufficient oral intake. During second-line and thirdline chemotherapy, 11/67 (16%) and 2/39 (5%) patients, respectively, exhibited improvements in oral intake; 85/428 (19.9%) and 70/259 (27.0%), respectively, exhibited deteriorations in oral intake. Factors correlated to deterioration in oral intake during second-line chemotherapy were poor Eastern Cooperative Oncology Group Performance Status (odds ratio, 4.32; P < 0.001), moderate or severe ascites (1.96; P = 0.045), peritoneal metastasis (2.12; P = 0.029), prior palliative surgery (3.41; P = 0.003), and high neutrophil-to-lymphocyte ratio (3.09; P < 0.001); those correlated to deterioration in oral intake during third-line chemotherapy were poorly differentiated pathology (2.52; P = 0.025) and high neutrophil-to-lymphocyte ratio (2.65; P = 0.006). Conclusion:As later-line chemotherapy is ineffective in improving oral intake in patients with AGC, careful adaptation of regimens is required for patients at risk for impaired oral intake.

Palliative interventions for patients with advanced gastric cancer: a systematic review

“…Five studies focused on QoL while receiving systemic therapies (71)(72)(73)(74)(75), three studies assessed QoL after surgical interventions (76)(77)(78), one study examined QoL after percutaneous liver ablation (79), two studies considered QoL during radiation treatments (80,81), two studies assessed QoL with nutritional interventions (82,83), two studies evaluated QoL in the last 6 months of life with or without the support of hospice services (84,85), and the last study examined the effects of low-frequency rotary magnetic fields on patients with symptomatic AGC (see Table 8 and Figure 5) (86). All studies were quantitative, as the only study reporting on the qualitative experiences of patients with gastric cancer did not specify that the patients in that study had AGC (87).…”

Short-term efficacy and influencing factors of conventional chemotherapy combined with irinotecan in patients with advanced gastric cancer

“…The short-term efficacy was evaluated by the World Health Organization (WHO) solid tumor treatment efficacy standards[ 10 ]. Complete remission (CR) was defined as the disappearance of the tumor lesion, which lasted for more than 4 wk, while partial remission (PR) was defined as a reduction in the lesion by more than 30%, which lasted for more than 4 wk.…”

Updated Immunotherapy for Gastric Cancer

“…If patients who did not receive immunotherapy in first-line treatment are unable to receive third-line treatment due to a poor general condition, they might not be able to receive immunotherapy during the entire course of palliative chemotherapy. One reason for not being able to receive subsequent systemic therapy is insufficient oral intake due to a primary tumor or peritoneal dissemination, thus requiring multidisciplinary care such as surgical gastrojejunostomy or endoscopic stent placement [ 104 , 105 , 106 , 107 ]. Data on immunochemotherapy for patients not eligible for clinical trials, such as poor performance status, insufficient oral intake, and disseminated intravascular coagulation syndrome, are lacking.…”