title: Association of fluoropyrimidines, platinum agents, taxanes, and irinotecan in any line of chemotherapy with survival in patients with advanced gastric cancer.
abstract: BACKGROUND
  Although fluoropyrimidines, platinum agents, taxanes, and irinotecan are used in the treatment of advanced gastric cancer (AGC), it remains unclear whether these agents in any line of chemotherapy are associated with overall survival (OS) in these patients.
  
  
  METHODS
  We retrospectively analyzed 704 patients with AGC. To avoid possible lead-time bias, we applied time-varying covariate analysis for chemotherapy with four agents in any line.
  
  
  RESULTS
  Median OS was 12.3 months. The frequency of exposure to each agent class during all lines of treatment was 92.6% for FU (5-fluorouracil or oral fluoropyrimidine), 48.2% for platinum agents, 65.1% for taxanes, and 39.1% for irinotecan. According to a multivariate Cox model with exposure to each agent class as a time-varying covariate, the hazard ratios (HRs) of death were 0.41 (95% confidence interval [CI], 0.27-0.57; p < 0.001) for FU, 0.71 (95% CI, 0.58-0.84; p < 0.001) for platinum agents, 0.51 (95% CI, 0.41-0.63; p < 0.001) for taxanes, and 0.53 (95% CI, 0.43-0.65; p < 0.001) for irinotecan. Although other agents were used in 18.6% of the patients, they did not affect survival.
  
  
  CONCLUSIONS
  Each of the four agent classes (FU, platinum agents, taxanes, and irinotecan) appears to be independently associated with improved OS in patients with AGC regardless of timing. This result suggests the importance of developing strategies which make these active agents available to all patients with AGC to prolong OS.
authors.affiliation: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi 464-8681, Japan. Kouheis0824@yahoo.co.jp
authors.forename: Kohei
authors.initials: K
authors.lastname: Shitara
authors.forename: Keitaro
authors.initials: K
authors.lastname: Matsuo
authors.forename: Ayako
authors.initials: A
authors.lastname: Mizota
authors.forename: Chihiro
authors.initials: C
authors.lastname: Kondo
authors.forename: Motoo
authors.initials: M
authors.lastname: Nomura
authors.forename: Daisuke
authors.initials: D
authors.lastname: Takahari
authors.forename: Tomoya
authors.initials: T
authors.lastname: Yokota
authors.forename: Takashi
authors.initials: T
authors.lastname: Ura
authors.forename: Seiji
authors.initials: S
authors.lastname: Ito
authors.forename: Akira
authors.initials: A
authors.lastname: Sawaki
authors.forename: Masahiro
authors.initials: M
authors.lastname: Tajika
authors.forename: Hiroki
authors.initials: H
authors.lastname: Kawai
authors.forename: Kei
authors.initials: K
authors.lastname: Muro
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002166:Camptothecin / Q000031:analogs & derivatives / Q000627:therapeutic use; D015331:Cohort Studies; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D000077146:Irinotecan; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017671:Platinum Compounds / Q000627:therapeutic use; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality*; D043823:Taxoids / Q000627:therapeutic use
chemical_list: D000970:Antineoplastic Agents; D017671:Platinum Compounds; D043823:Taxoids; D000077146:Irinotecan; D005472:Fluorouracil; D002166:Camptothecin