Early versus Delayed Therapy of Advanced Gastric Cancer Patients - Does It Make a Difference?

Abstract

Background: Nearly 50% of gastric cancer patients are diagnosed with advanced gastric cancer (AGC). Therapy is palliative but results in ill effects. The median overall survival (OS) of AGC patients is often <12 months. It is unclear if the early initiation of therapy in all AGC patients is beneficial. Methods: A retrospective analysis of AGC patients in our database was carried out. The patients were divided into two groups: asymptomatic or symptomatic. We sought to assess whether the delay of systemic therapy was harmful in asymptomatic patients. Results: A total of 135 patients were analyzed. Most patients were symptomatic (68%), males (67%), and had low ECOG scores (0-1; 85%). In univariate analyses, ECOG performance status 0 (p = 0.005), delayed initiation of therapy (p = 0.03), and lack of symptoms (p = 0.03) were associated with a longer OS. The multivariate model for OS identified only ECOG performance status as an independent prognosticator of longer OS (p = 0.02). Asymptomatic patients who had delayed (≥4 weeks) systemic therapy had an OS rate of 77% at 1 year compared to 58% for patients treated within 4 weeks (p = 0.47). Conclusion: Symptomatic AGC patients had a poor outcome compared to asymptomatic AGC patients. Treatment delay in asymptomatic patients had no detrimental effect on OS, suggesting that the timing of therapy can be based on patient selection.

Stereotactic body radiotherapy to defer systemic therapy in patients with oligorecurrent disease

“…A retrospective observational study utilizing the National Cancer Data Base found that delayed targeted therapy was not associated with worse OS in patients with metastatic renal-cell carcinoma [26] . A retrospective single center analysis from MD Anderson Cancer Center found that in patients with asymptomatic advanced gastric cancer, delayed systemic therapy did not result in detrimental OS [6] . These studies indicate that in carefully selected patients with advanced cancer, outcomes might not be compromised by surveillance and delayed systemic therapy.…”

Impact of time from diagnosis to chemotherapy in advanced gastric cancer: A Propensity Score Matching Study to Balance Prognostic Factors

“…Based on these findings, a long WT for resectable solid cancer might be associated with a worse prognosis, but this association might depend on the volume of cancer patients in the particular hospital. However, there have been few reports on whether a delay in the initiation of chemotherapy for unresectable solid cancer will lead to adverse outcomes among patients[17].…”

“…Although propensity score matching analysis was used, it cannot enough remove selection bias for a single center and a small sample size study. However, Elimova et al[17] also reported that asymptomatic patients with delayed therapy (≥ 4 wk) had a good OS compared with patients with early therapy (< 4 wk), but the difference was not significant. They concluded that asymptomatic patients with delayed therapy had no detrimental effect on OS, suggesting that the timing of therapy can be based on patient selection.…”

Impact of Sites of Metastatic Dissemination on Survival in Advanced Gastroesophageal Adenocarcinoma

“…However, there are no validated clinicopathologic or biomarkers to help risk stratify patients with metastatic disease. Existing data, largely limited to population level registries, have identified several poor prognostic factors, including advanced age, male gender, poor Eastern Cooperative Oncology Group performance status (ECOG PS), primary tumor location, and presence of peritoneal metastasis [ 3 , 17 , 18 , 19 , 20 ]. Younger age, female gender, good performance status at diagnosis, and treatment with palliative chemotherapy have been associated with improved survival [ 20 , 21 ].…”