title: Prognostic factors of second and third line chemotherapy using 5-fu with platinum, irinotecan, and taxane for advanced gastric cancer.
abstract: OBJECTIVE
  The aims of this study are to find out whether the sequence of chemotherapeutic regimens including second- and third-line taxane and irinotecan influences the survival of patients with unresectable gastric carcinoma and to identify clinical characteristics of patients with improved response.
  
  
  METHODS
  Fifty gastric carcinoma patients who were treated by third-line sequential chemotherapy between November 2004 and July 2010 were enrolled in this study. Their overall survival (OS) and time to progression (TTP) were set up as primary and secondary end points. For the sequence of chemotherapy regimen, two arms were used. Arm A was defined as 5-fluorouracil (5-FU)+cisplatin (FP) or folinic acid, 5-FU and oxaliplati (FOLFOX), followed by folinic acid, 5-FU and irinotecan (FOLFIRI), and paclitaxel or docetaxel plus 5-FU, with or without epirubicin. Arm B was defined as FP or FOLFOX, followed by paclitaxel or docetaxel plus 5-FU, and FOLFIRI.
  
  
  RESULTS
  The median OS of all patients was 16.0 months (95% confidence interval, 13.6 to 18.3 months), which is longer than historical control of patients who did not receive third-line chemotherapy. The sequence of second and third-line regimen, including irinotecan and taxane, did not present significant difference in OS or TTP after failure of 5-FU with platinum chemotherapy. In survival analysis of patients' clinicopathologic characteristics, poor prognosis was shown in patients with poorly differentiated histologic features, elevated serum carcinoembryonic level, and shorter TTP of first line chemotherapy.
  
  
  CONCLUSIONS
  It is possible for patients to respond differently to chemotherapy due to differences in clinical features and underlying gene expression profiles. Development of individualized chemotherapy regimens based on gene expression profiles is warranted.
authors.affiliation: Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
authors.forename: Ji Soo
authors.initials: JS
authors.lastname: Park
authors.forename: Jae Yun
authors.initials: JY
authors.lastname: Lim
authors.forename: Seung Kyo
authors.initials: SK
authors.lastname: Park
authors.forename: Min Kyung
authors.initials: MK
authors.lastname: Kim
authors.forename: Hee Sung
authors.initials: HS
authors.lastname: Ko
authors.forename: Sun Och
authors.initials: SO
authors.lastname: Yoon
authors.forename: Jong Won
authors.initials: JW
authors.lastname: Kim
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Choi
authors.forename: Jae Yong
authors.initials: JY
authors.lastname: Cho