title: Early versus Delayed Therapy of Advanced Gastric Cancer Patients--Does It Make a Difference?
abstract: BACKGROUND
  Nearly 50% of gastric cancer patients are diagnosed with advanced gastric cancer (AGC). Therapy is palliative but results in ill effects. The median overall survival (OS) of AGC patients is often <12 months. It is unclear if the early initiation of therapy in all AGC patients is beneficial.
  
  
  METHODS
  A retrospective analysis of AGC patients in our database was carried out. The patients were divided into two groups: asymptomatic or symptomatic. We sought to assess whether the delay of systemic therapy was harmful in asymptomatic patients.
  
  
  RESULTS
  A total of 135 patients were analyzed. Most patients were symptomatic (68%), males (67%), and had low ECOG scores (0-1; 85%). In univariate analyses, ECOG performance status 0 (p = 0.005), delayed initiation of therapy (p = 0.03), and lack of symptoms (p = 0.03) were associated with a longer OS. The multivariate model for OS identified only ECOG performance status as an independent prognosticator of longer OS (p = 0.02). Asymptomatic patients who had delayed (≥ 4 weeks) systemic therapy had an OS rate of 77% at 1 year compared to 58% for patients treated within 4 weeks (p = 0.47).
  
  
  CONCLUSIONS
  Symptomatic AGC patients had a poor outcome compared to asymptomatic AGC patients. Treatment delay in asymptomatic patients had no detrimental effect on OS, suggesting that the timing of therapy can be based on patient selection.
authors.affiliation: Department of Gastrointestinal Medical Oncology, University of Texas M.D. Anderson Cancer Center, Houston, Tex., USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Elimova
authors.forename: Hironori
authors.initials: H
authors.lastname: Shiozaki
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Slack
authors.forename: Hsiang-Chun
authors.initials: HC
authors.lastname: Chen
authors.forename: Roopma
authors.initials: R
authors.lastname: Wadhwa
authors.forename: Kazuki
authors.initials: K
authors.lastname: Sudo
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Charalampakis
authors.forename: Adarsh
authors.initials: A
authors.lastname: Hiremath
authors.forename: Jeannelyn S
authors.initials: JS
authors.lastname: Estrella
authors.forename: Aurelio
authors.initials: A
authors.lastname: Matamoros
authors.forename: Tara
authors.initials: T
authors.lastname: Sagebiel
authors.forename: Prajnan
authors.initials: P
authors.lastname: Das
authors.forename: Jane E
authors.initials: JE
authors.lastname: Rogers
authors.forename: Jeana L
authors.initials: JL
authors.lastname: Garris
authors.forename: Mariela A
authors.initials: MA
authors.lastname: Blum
authors.forename: Brian
authors.initials: B
authors.lastname: Badgwell
authors.forename: Jaffer A
authors.initials: JA
authors.lastname: Ajani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents