Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world

Fanotto, Valentina; Cordio, S.; Pasquini, Giulia; Fontanella, Caterina; Rimassa, Lorenza; Leone, Francesco; Rosati, Gerardo; Santini, Daniele; Donato, Samantha Di; Tomasello, Gianluca; Silvestris, Nicola; Pietrantonio, Filippo; Battaglin, Francesca; Avallone, Antonio; Scartozzi, Mario; Lutrino, E.S.; Melisi, Davide; Antonuzzo, Lorenzo; Pellegrino, A.; Torri, Valter; Aprile, Giuseppe

doi:10.1007/s10120-016-0681-6

Cited by 33 publications

(33 citation statements)

References 24 publications

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“…A complete response to second‐line chemotherapy was achieved in 7 patients and a partial response in 42 patients, for an ORR of 16.3%. Detailed results of the whole cohort of nearly 900 patients who received a second‐line treatment have already been reported elsewhere . Eastern Cooperative Oncology Group performance status at the start of the third‐line therapy was 0 or 1 in 234 patients (78%).…”

Section: Resultsmentioning

confidence: 92%

“…This is a multicenter, retrospective study involving 19 Italian oncology departments, homogeneously located throughout the country. Medical records of approximately 2,200 AGC patients treated from May 2000 to February 2015 were reviewed: among 868 patients who received at least two lines of systemic therapy , we retrospectively analyzed baseline parameters, tumor characteristics, and treatment data of those treated with three lines. In particular, of 331 patients who had received a third‐line therapy, we conducted the analyses on 300 patients for whom we had information about treatment type received in third‐line.…”

Section: Methodsmentioning

confidence: 99%

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Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy

Fanotto

Uccello

Pecora³

et al. 2017

The Oncologist

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Background Second‐line therapy has consistently demonstrated survival benefit if compared with best supportive care; however, there is limited evidence whether further lines of treatment may improve the prognosis of advanced gastric cancer (AGC) patients. Materials and Methods Starting from a real‐world cohort of 868 AGC patients, we retrospectively analyzed baseline parameters, tumor characteristics, and treatment data of those treated with at least three lines. Categorical features were described through cross‐tables and chi‐square test. We explored the impact of treatment intensity and progression‐free survival (PFS) experienced in previous lines on PFS and overall survival in third‐line by uni‐ and multivariate Cox regression models and described by Kaplan‐Meier estimator plot with log‐rank test. Results Overall, 300 patients were included in the analysis. The most common site of primary tumor was gastric body; 45.3% of cancers had an intestinal histotype, 14% were human epidermal growth receptor 2 positive. In third‐line, 45.7% of patients received a single‐agent chemotherapy, 49.7% a combination regimen. Patients who had experienced a first‐line PFS ≥6.9 months had a better prognosis compared with those who had achieved a shorter one. Consistently, a second‐line PFS ≥3.5 months positively influenced the prognosis. Patients receiving a third‐line combination regimen had better outcomes compared with those treated with a single‐agent chemotherapy. Conclusion Our real‐world study confirms that selected AGC patients may receive third‐line treatment. Longer PFS in previous lines or a more intense third‐line treatment positively influenced prognosis. Further efforts are warranted to define the best therapeutic sequences, and to identify the optimal candidate for treatment beyond second‐line. Implications for Practice The benefit of third‐line treatment to advanced gastric cancer patients is controversial. This study depicts a real scenario of the clinical practice in Italy, confirming that a non‐negligible proportion of patients receive a third‐line therapy. Longer progression‐free survival in previous treatment lines or higher third‐line treatment intensity positively influenced prognosis. Including a large number of real‐world patients, this study provides information on third‐line treatment from the daily clinical practice; moreover, its results help in defining the best therapeutic sequence and offer some hints to select the optimal candidate for treatment beyond second‐line.

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Section: Resultsmentioning

confidence: 92%

Section: Methodsmentioning

confidence: 99%

Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy

Fanotto

Uccello

Pecora³

et al. 2017

The Oncologist

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“…The developing cohort included two previously investigated Italian series of patients treated with ramucirumab-based therapy (RAMoss study) [14] or with any second-line treatment [13] The nomogram endpoint was OS; we would predict the 3-and 6-month OS probability, the former because life expectancy of 3 months is required for enrollment in clinical trials and the latter being more similar to the median OS in second-line trials. The candidate prognostic variables were baseline clinical and pathological parameters derived in the two Italian studies [13,14], i.e., age, sex, ECOG PS, primary tumor site (gastroesophageal junction or stomach), Lauren's histotype (intestinal, diffused, other), primary tumor resection (yes, no), presentation of metastases (metachronous, synchronous), number of metastatic sites (1, 2, ≥3), specific sites of metastases (peritoneal, extraregional lymph nodes, liver, lung), laboratory tests (neutrophils to lymphocytes [N/L] ratio, lactate dehydrogenase), first-line objective response, and firstline progression-free survival.…”

Section: Study Design and Cohort Descriptionmentioning

confidence: 99%

“…The candidate prognostic variables were baseline clinical and pathological parameters derived in the two Italian studies [13,14], i.e., age, sex, ECOG PS, primary tumor site (gastroesophageal junction or stomach), Lauren's histotype (intestinal, diffused, other), primary tumor resection (yes, no), presentation of metastases (metachronous, synchronous), number of metastatic sites (1, 2, ≥3), specific sites of metastases (peritoneal, extraregional lymph nodes, liver, lung), laboratory tests (neutrophils to lymphocytes [N/L] ratio, lactate dehydrogenase), first-line objective response, and firstline progression-free survival.…”

Section: Study Design and Cohort Descriptionmentioning

confidence: 99%

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Estimating Survival Probabilities of Advanced Gastric Cancer Patients in the Second-Line Setting: The Gastric Life Nomogram

et al. 2018

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Objective: We built and externally validated a nomogram for predicting the overall survival (OS) probability of advanced gastric cancer patients receiving second-line treatment. Methods: The nomogram was developed on a set of 320 Italian patients and validated on two independent sets (295 Italian and 172 Korean patients). Putative prognostic variables were selected using a random forest model and included in the multivariable Cox model. The nomogram’s performance was evaluated by calibration plot and C index. Results: ECOG performance status, neutrophils to lymphocytes ratio, and peritoneal involvement were selected and included into the multivariable model. The C index was 0.72 (95% CI 0.68–0.75) in the development set, 0.69 (95% CI 0.65–0.73) in the Italian validation set, but only 0.57 (95% CI 0.52–0.62) in the Korean set. While Italian calibrations were quite good, the Korean one was poor. Regarding 6-month OS predictions, calibration was best in both Caucasian cohorts and worst the in Asian one. Conclusions: Our nomogram may be a useful tool to predict 3- or 6-month OS in Caucasian gastric cancer patients eligible for second-line therapy. Based on three easy-to-collect variables, the Gastric Life nomogram may help clinicians improve patient selection for second-line treatments and assist in clinical trial enrollment.

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Development and validation of pretreatment nomogram for disease‐specific mortality in gastric cancer‐A competing risk analysis

Bando

Kattan

et al. 2021

Cancer Medicine

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Prognostic factors in 868 advanced gastric cancer patients treated with second-line chemotherapy in the real world

Cited by 33 publications

References 24 publications

Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy

Outcomes of Advanced Gastric Cancer Patients Treated with at Least Three Lines of Systemic Chemotherapy

Estimating Survival Probabilities of Advanced Gastric Cancer Patients in the Second-Line Setting: The Gastric Life Nomogram

Development and validation of pretreatment nomogram for disease‐specific mortality in gastric cancer‐A competing risk analysis

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