title: Outcomes of multiple salvage chemotherapy for advanced gastric cancer: implications for clinical practice and trial design.
abstract: OBJECTIVE
  We analyzed the natural history of advanced gastric cancer with sequential salvage chemotherapy following first-line treatment.
  
  
  METHODS
  We studied 532 patients with unresectable gastric adenocarcinoma who were treated at Yonsei Cancer Center (2000-2008). The patients were managed with multiple sequential salvage chemotherapy as allowed by performance status and toxicity profiles. The tumor response was assessed every two cycles.
  
  
  RESULTS
  Four hundred sixty patients received palliative chemotherapy and 72 received supportive care only. The median overall survival was 12.0 months for all patients, 12.1 months for the chemotherapy group, and 2.5 months for the supportive care group (P < 0.001). In the chemotherapy group, 87% received first-line chemotherapy, 47% second-line, 23% third-line, 9% fourth-line, and 3% fifth-line. Response rates were 24.8, 12.6, 10.9, 2.6, and 0% and disease control rates were 76.3, 60.1, 54.2, 54.2, and 53.3% for first- to fifth-line treatment, respectively. The median progression-free survival was 5.5, 3.4, 2.5, 1.9, and 2.0 months and overall survival was 12.1, 7.9, 5.5, 5.0, and 6.8 months. Performance status and metastatic pattern were consistent prognostic factors throughout salvage treatment.
  
  
  CONCLUSIONS
  Clinical trials may be feasible in second- or third-line salvage chemotherapy for gastric cancer. Future clinical trials in these settings should take into account the low response rate, short progression-free survival, and the prognostic factors for optimal trial design.
authors.affiliation: Cancer Metastasis Research Center, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea.
authors.forename: Yong Wha
authors.initials: YW
authors.lastname: Moon
authors.forename: Sun Young
authors.initials: SY
authors.lastname: Rha
authors.forename: Hei-Cheul
authors.initials: HC
authors.lastname: Jeung
authors.forename: Chan
authors.initials: C
authors.lastname: Kim
authors.forename: Min Hee
authors.initials: MH
authors.lastname: Hong
authors.forename: Hyun
authors.initials: H
authors.lastname: Chang
authors.forename: Jae Kyung
authors.initials: JK
authors.lastname: Roh
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Noh
authors.forename: Byung Soo
authors.initials: BS
authors.lastname: Kim
authors.forename: Hyun Cheol
authors.initials: HC
authors.lastname: Chung
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011379:Prognosis; D012107:Research Design; D012189:Retrospective Studies; D016879:Salvage Therapy; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000970:Antineoplastic Agents