Comparison of Treatment Efficacy and Survival Outcomes Between Asian and Western Patients With Unresectable Gastric or Gastro-Esophageal Adenocarcinoma: A Systematic Review and Meta-Analysis

Zhang, Zhening; Liu, Zining; Chen, Zeyang

doi:10.3389/fonc.2022.831207

Cited by 9 publications

(5 citation statements)

References 43 publications

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“…First, it was not randomized and provided only a small sample size of patients. Furthermore, it enrolled only European patients with advanced gastric cancer and previous results of a meta‐analysis showed better clinical outcome for Western patients receiving antiangiogenic agents compared to Asian patients (HR 0.79; 95% CI: 0.64‐0.97 vs HR 0.96; 95% CI: 0.72‐1.28), although the interregional difference was not statistically significant 18 . Therefore, the very promising antitumor activity in our results is encouraging but requires confirmation in a larger, randomized study.…”

Section: Discussionmentioning

confidence: 99%

Ramucirumab beyond progression plus TAS‐102 in patients with advanced or metastatic esophagogastric adenocarcinoma, after treatment failure on a ramucirumab‐based therapy

Goetze

Stein

Lorenzen

et al. 2023

Intl Journal of Cancer

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Based on results of prior trials (TAGS, REGARD, RAINBOW), the combination of ramucirumab beyond progression with TAS‐102 (trifluridine/tipiracil) seems to be promising in advanced esophagogastric adenocarcinoma (EGA). In this multicenter, non‐randomized, open‐label, investigator‐initiated pilot trial, ramucirumab‐pretreated patients with metastatic EGA received a maximum of 4 cycles of ramucirumab (8 mg/kg i.v. on day 1 and 15, Q2W) plus TAS‐102 (35 mg/m2 p.o. bid on day 1‐5 and day 8‐12; Q2W). Primary endpoint was tolerability and toxicity, defining a positive trial if the SAE rate according to CTCAE 5.0 will increase <30% (up to 55%) compared to historical results from TAGS trial (SAE rate 43%). Secondary endpoints were further evaluation of safety and assessment of efficacy according to tumor response and overall and progression‐free survival (OS/PFS). Twenty patients, 20% gastric and 80% GEJ cancers and 55% with ECOG 0 were enrolled. In total, nine SAEs were reported in 25% [95% CI: 8.7‐49.1] of the patients, all without relationship to the systemic therapy. The median OS and PFS were 9.1 months [5.4‐10.1] and 2.9 months [1.7‐4.8], respectively. In addition, a disease control rate of 45% was obtained. The trial showed a favorable safety profile with a numerically lower incidence of SAEs for the combination of ramucirumab with TAS‐102 compared to historical TAGS trial. Furthermore, the combination demonstrated efficacy in the beyond progression setting and therefore warrants further evaluation in a randomized trial compared to TAS‐102 alone.

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Section: Discussionmentioning

confidence: 99%

Ramucirumab beyond progression plus TAS‐102 in patients with advanced or metastatic esophagogastric adenocarcinoma, after treatment failure on a ramucirumab‐based therapy

Goetze

Stein

Lorenzen

et al. 2023

Intl Journal of Cancer

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“…The fixed-effect model combined the effect size HR, which was 78% and significant (z=4.58, P=0.00001<0.05), meaning that immunotreatment-based regimens significantly reduced the risk of death in the non-Asian population, to only 78% of that of chemotherapy alone. Zhang et al ( 29 ) showed that Asian and Western patients have similar responses to systemic therapy in unresectable gastric or gastroesophageal adenocarcinoma. However, first-line immunotherapy in Asian populations showed better OS in unresectable gastric or gastroesophageal adenocarcinoma than in Western populations.…”

Section: Discussionmentioning

confidence: 99%

The efficacy and safety of first‑line anti‑PD‑1/PD‑L1 immunotherapy for gastric esophageal cancer: A systematic review and meta‑analysis of phase III randomized controlled trials

Duan

et al. 2023

Exp Ther Med

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Immunotherapy-based regiments have potential as first-line treatment for advanced gastric esophageal cancer. The present study aimed to conduct a meta-analysis of the association between the efficacy and safety of first-line immunotherapy combined with chemotherapy in patients with unresectable locally advanced or metastatic gastric esophageal cancer. Subgroup analysis of patients with programmed death ligand 1 (PD-L1) combined positive score (CPS) was conducted to identify the characteristics of patients with immune benefit and to provide a decision-making basis for clinical practice. PubMed, Embase, Cochrane Library and other databases were searched to collect randomized controlled trials of immunotreatment-based regimens (experimental group) versus conventional first-line chemotherapy regimens (control group) for unresectable locally advanced or metastatic gastric esophageal cancer. The main outcome measures included progression-free survival (PFS), overall survival (OS), objective response rate, disease control rate and safety, and the secondary outcomes were the differences in OS and PFS between patients with PD-L1 CPS ≥10 and those with PD-L1 CPS <10. In addition, Asian and non-Asian populations were analysed. Nine studies with a total of 6,820 patients were included. The OS of patients treated with immunotherapy-based regimens was significantly longer than that of those treated with chemotherapy alone [HR=0.74; 95% CI (0.69, 0.80); P<0.00001]. The OS of patients with PD-L1 CPS ≥10 and PD-L1 CPS <10 in the experimental group was significantly longer than that of patients in the control group [HR=0.68; 95% CI (0.59, 0.77); P<0.00001 and HR=0.73; 95% CI (0.62, 0.87); P=0.0005]. The PFS of patients being treated with immunotherapy-based regimens was significantly longer than that of those treated with chemotherapy alone [HR=0.71; 95% CI (0.59, 0.86); P=0.0003]. In addition, the PFS of patients with PD-L1 CPS ≥10 and PD-L1 CPS <10 in the experimental group was significantly longer than that of patients in the control group [HR= 0.67; 95% CI (0.49, 0.92); P= 0.01 and HR= 0.63; 95% CI (0.48, 0.83); P= 0.001]. There was no significant difference in the overall incidence of adverse events and the incidence of grade 3 or above adverse events between the experimental and control groups [RR=1; 95% CI (0.99, 1.02); P= 0.65 and RR= 0.97; 95% CI (0.84, 1.12); P= 0.69, respectively]. In conclusion, treatment with immunotherapy-based regimens may prolong the OS of patients with unresectable locally advanced or metastatic gastric esophageal cancer and this treatment regimen is safe compared with chemotherapy alone.

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“…Unresectable cases present a dismal prognosis, with median overall survival rates ranging from 11 to 14 months, and 5-year survival rates of less than 30% [ 131 , 132 , 133 , 134 ]. Notably, patients eligible for targeted therapy or immunotherapy exhibit significantly higher survival rates overall [ 135 , 136 ]. However, numerous authors highlight the need to refine patient selection for these treatments, enhance drug efficacy, identify new therapeutic targets, and overcome treatment resistance [ 137 , 138 , 139 , 140 ].…”

Section: Gastric Cancer Characterization Prognosis and Management In ...mentioning

confidence: 99%

Molecular Classifications in Gastric Cancer: A Call for Interdisciplinary Collaboration

Díaz del Arco,

Fernández Aceñero,

Ortega Medina

2024

IJMS

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Gastric cancer (GC) is a heterogeneous disease, often diagnosed at advanced stages, with a 5-year survival rate of approximately 20%. Despite notable technological advancements in cancer research over the past decades, their impact on GC management and outcomes has been limited. Numerous molecular alterations have been identified in GC, leading to various molecular classifications, such as those developed by The Cancer Genome Atlas (TCGA) and the Asian Cancer Research Group (ACRG). Other authors have proposed alternative perspectives, including immune, proteomic, or epigenetic-based classifications. However, molecular stratification has not yet transitioned into clinical practice for GC, and little attention has been paid to alternative molecular classifications. In this review, we explore diverse molecular classifications in GC from a practical point of view, emphasizing their relationships with clinicopathological factors, prognosis, and therapeutic approaches. We have focused on classifications beyond those of TCGA and the ACRG, which have been less extensively reviewed previously. Additionally, we discuss the challenges that must be overcome to ensure their impact on patient treatment and prognosis. This review aims to serve as a practical framework to understand the molecular landscape of GC, facilitate the development of consensus molecular categories, and guide the design of innovative molecular studies in the field.

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Comparison of Treatment Efficacy and Survival Outcomes Between Asian and Western Patients With Unresectable Gastric or Gastro-Esophageal Adenocarcinoma: A Systematic Review and Meta-Analysis

Cited by 9 publications

References 43 publications

Ramucirumab beyond progression plus TAS‐102 in patients with advanced or metastatic esophagogastric adenocarcinoma, after treatment failure on a ramucirumab‐based therapy

Ramucirumab beyond progression plus TAS‐102 in patients with advanced or metastatic esophagogastric adenocarcinoma, after treatment failure on a ramucirumab‐based therapy

The efficacy and safety of first‑line anti‑PD‑1/PD‑L1 immunotherapy for gastric esophageal cancer: A systematic review and meta‑analysis of phase III randomized controlled trials

Molecular Classifications in Gastric Cancer: A Call for Interdisciplinary Collaboration

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