Outcomes of multiple salvage chemotherapy for advanced gastric cancer: implications for clinical practice and trial design.
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.
Moon
Yong Wha
YW
Cancer Metastasis Research Center, Yonsei University College of Medicine, 250 Seongsanno, Seodaemun-gu, Seoul, Korea.
Rha
Sun Young
SY
Jeung
Hei-Cheul
HC
Kim
Chan
C
Hong
Min Hee
MH
Chang
Hyun
H
Roh
Jae Kyung
JK
Noh
Sung Hoon
SH
Kim
Byung Soo
BS
Chung
Hyun Cheol
HC
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
D000970:Antineoplastic Agents