Survival impact of post-progression chemotherapy in advanced gastric cancer: systematic review and meta-analysis

Iizumi, Sakura; Takashima, Atsuo; Sakamaki, Kentaro; Morita, Satoshi; Boku, Narikazu

doi:10.1007/s00280-018-3569-9

Cited by 34 publications

(31 citation statements)

References 46 publications

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“…Little is understood about the prognostic impact of subsequent therapeutic intervention after discontinuation of immunotherapy. However, a systematic review and metaanalysis demonstrated that post-progression subsequent chemotherapy after both first-line and secondline regimens was significantly associated with longer OS in patients with advanced gastric cancer [17]. This meta-analysis recommended third-line chemotherapy after second-line chemotherapy to improve the prognosis [17].…”

Section: Discussionmentioning

confidence: 94%

“…However, a systematic review and metaanalysis demonstrated that post-progression subsequent chemotherapy after both first-line and secondline regimens was significantly associated with longer OS in patients with advanced gastric cancer [17]. This meta-analysis recommended third-line chemotherapy after second-line chemotherapy to improve the prognosis [17]. Accordingly, post-progression salvage chemotherapy after nivolumab may have a survival benefit as a fourth-line treatment.…”

Section: Discussionmentioning

confidence: 97%

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Response Rate and Prognostic Impact of Salvage Chemotherapy after Nivolumab in Patients with Advanced Gastric Cancer

et al. 2020

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Objective: Nivolumab is recommended as a third-line treatment in patients with unresectable advanced or recurrent gastric cancer. Although recent studies have demonstrated the prognostic impact of salvage chemotherapy after immune checkpoint inhibitors in several malignancies, its clinical significance remains unclear in patients with gastric cancer. This study aimed to investigate tumor response to subsequent chemotherapy after nivolumab in patients with advanced gastric cancer and assess the prognostic effect of salvage chemotherapy. Methods: We retrospectively enrolled 31 patients with unresectable advanced or recurrent gastric cancer receiving nivolumab. Results: Twenty-two and nine patients received nivolumab as third-line and fourth-to sixth-line treatments, respectively. The objective response rate (ORR) and disease control rate (DCR) to nivolumab were 20.0% (4/20) and 55.0% (11/20), respectively. Eleven patients received salvage chemotherapy after nivolumab. The ORR and DCR to salvage chemotherapy were 37.5% (3/8) and 75.0% (6/8), respectively. The median progression-free survival and overall survival following salvage chemotherapy were 285 and 360 days, respectively. Conclusion: Our preliminary study indicates that nivolumab exposure may enhance subsequent chemosensitivity in patients with advanced gastric cancer.

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 97%

Response Rate and Prognostic Impact of Salvage Chemotherapy after Nivolumab in Patients with Advanced Gastric Cancer

et al. 2020

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“…A recent systematic review with a meta-analysis showed the proportion of patients receiving postprogression chemotherapy correlated with the postprogression survival and the OS both for first-and secondline chemotherapy [43]. In a limited survival time for the recurrent gastric cancer patients, appropriate use with a limited number of effective drugs is essential to improve survival.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Systemic Inflammatory Response and Nutritional Biomarkers as Predictive Factors in Patients with Recurrent Gastric Cancer

et al. 2020

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Background: The present study sought to evaluate host-related factors as predictors in patients receiving chemotherapy for recurrent advanced gastric cancer. Methods: Sixtythree patients were enrolled in the study and received chemotherapy for recurrent gastric cancer at the Kochi Medical School from 2008 to 2015. Clinicopathological information and systemic inflammatory response data were obtained retrospectively to investigate associations between baseline cancer-related prognostic variables and survival outcomes. Results: The median survival time was significantly higher for patients with a Glasgow prognostic score (GPS) of 0 compared to a GPS of 1 or 2 (18.2 vs. 7.1 months; p = 0.006), and for patients in the normal range for carbohydrate antigen-125 (CA125) compared to higher levels (17.9 vs. 4.1 months; p = 0.003). There was no significant influence on overall survival by age, gender, disease status, metastatic site, time to recurrence, carcinoembryonic antigen level, CA19-9 level, prognostic nutrition index, or neutrophil to lymphocyte ratio according to the results of the univariate log-rank tests. Multivariate survival analysis identified a GPS of 1 or 2 (hazard ratio, 3.520; 95% confidence interval, 1.343-9.227; p = 0.010) and a high CA125 level (hazard ratio, 3.135; 95% confidence interval, 1.276-7.697; p = 0.013) as significant independent predictors associated with a poorer prognosis in the studied group of cancer patients. Conclusions: A GPS of 1 or 2 and a high level of CA125 are independent predictors of a poorer prognosis in patients receiving chemotherapy for recurrent gastric cancer.

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“…Second-line chemotherapy for AGC is provided more frequently in Japan than in other countries, as shown by a high proportion of patients (approximately 75%-80%) receiving second-line chemotherapy in several Japanese phase III trials [2,4,12]. Second-line chemotherapy is effective in prolonging the survival time of patients [14]. As shown in the RAINBOW trial, the combination therapy of paclitaxel and ramucirumab, which targets vascular endothelial growth factor receptor-2, has been established as a new standard second-line treatment for AGC [5].…”

Section: Discussionmentioning

confidence: 99%

Second-line chemotherapy using taxane in patients with advanced gastric cancer who presented with severe peritoneal metastasis: A multicenter retrospective study

Arai

Kawahira

Yasui

et al. 2019

Preprint

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Background Individuals with advanced gastric cancer (AGC) who present with severe peritoneal metastasis (SPM) have poor prognosis, and the need to improve treatment for such condition and survival time is not met. Moreover, there are only few data about the second-line treatment for patients with such condition. Methods This retrospective study included patients receiving taxane-based second-line chemotherapy at three institutions in Japan between 2010 and 2016. Patients with AGC who present with SPM were included if they had massive ascites and/or inadequate oral intake requiring intravenous nutritional support. The efficacy and safety of the treatment were evaluated. Results In the present study, 43 (40%) of 108 patients had an Eastern Cooperative Oncology Group Performance Status score > 2, and the median serum albumin level of the patients was 3.3 g/mL. Ramucirumab was used in combination with paclitaxel in 21 patients. The median overall survival (OS) and progression-free survival (PFS) were 5.1 and 2.8 months, respectively. Inadequate oral intake was considered a negative prognostic factor of both OS and PFS in the multivariate analysis. Three treatment-related deaths were observed, which include those attributed to febrile neutropenia, gastrointestinal perforation, and pneumonitis. Common grade > 3 adverse events were neutropenia (35%), leukopenia (30%), anemia (24%), and anorexia (16%). We observed febrile neutropenia in 8% and gastrointestinal perforation in 4% of patients, and such conditions were primarily observed in patients with inadequate oral intake. Conclusions Taxane-based second-line chemotherapy was effective and safe for patients with AGC who present with SPM. Attention must be provided when treating patients with inadequate oral intake as they are likely to have short prognosis and serious toxicities.

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Survival impact of post-progression chemotherapy in advanced gastric cancer: systematic review and meta-analysis

Abstract: Post-Cx% both after 1st-Cx and 2nd-Cx were correlated with mOS/mPPS, suggesting a survival benefit of 3rd-Cx in addition to that of 2nd-Cx for AGC.

Cited by 34 publications

References 46 publications

Response Rate and Prognostic Impact of Salvage Chemotherapy after Nivolumab in Patients with Advanced Gastric Cancer

Response Rate and Prognostic Impact of Salvage Chemotherapy after Nivolumab in Patients with Advanced Gastric Cancer

Evaluation of Systemic Inflammatory Response and Nutritional Biomarkers as Predictive Factors in Patients with Recurrent Gastric Cancer

Second-line chemotherapy using taxane in patients with advanced gastric cancer who presented with severe peritoneal metastasis: A multicenter retrospective study

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