title: Impact of clinical response to first-line chemotherapy on gastric cancer patients treated with second-line and third-line chemotherapy.
abstract: OBJECTIVE
  A combination regimen of up to three cytotoxic agents have been delivered in the West whereas single agent or two-drug combination regimens have been used sequentially in Japan for patients with unresectable/recurrent gastric cancer. Patients treated with chemotherapy in a single Japanese institution were analyzed to identify patients who benefit from higher lines of chemotherapy.
  
  
  METHODS
  A prospective database was searched for patients with advanced/recurrent gastric carcinoma who underwent chemotherapy between 2002 and 2008. When the front line treatment failed, further therapy was offered unless performance status (PS) was >2 or when the patient declined to receive further treatment. The clinical tumor response and overall survival after each line of treatment were assessed.
  
  
  RESULTS
  Sixty-four consecutive patients were identified, of which 46 patients (72%) underwent second-line chemotherapy and 22 (34%) underwent third-line. Disease stabilization (best overall response of other than PD) and positive cytological examination (CY1) as a sole cause of non-curative resection were identified as indicators of long survival after the first-line therapy. Disease stabilization observed at the first-line therapy was found to be a significant predictor of survival after initiation of the second-line and third-line therapies.
  
  
  CONCLUSIONS
  The current study delineates that the response to the first-line treatment can be used to predict the effect of higher lines of treatment.
authors.affiliation: Department of Surgery II, Nagoya University School of Medicine, Nagoya, Aichi, Japan. ykodera@med.nagoya-u.ac.jp
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Kodera
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Ito
authors.forename: Norifumi
authors.initials: N
authors.lastname: Ohashi
authors.forename: Goro
authors.initials: G
authors.lastname: Nakayama
authors.forename: Masahiko
authors.initials: M
authors.lastname: Koike
authors.forename: Michitaka
authors.initials: M
authors.lastname: Fujiwara
authors.forename: Akimasa
authors.initials: A
authors.lastname: Nakao
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D011446:Prospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000970:Antineoplastic Agents