Skip to main content

Advertisement

Log in

Clinical outcomes in 66 patients with advanced gastric cancer treated in phase I trials: the NCCHE experience

  • PHASE I STUDIES
  • Published:
Investigational New Drugs Aims and scope Submit manuscript

Summary

Background Although patients with advanced gastric cancer (AGC) have a poor prognosis when conventional therapies fail, they are often candidates for phase I trials. However, there is no detailed report on clinical outcomes of patients with AGC treated in phase I trials. Methods We retrospectively reviewed the medical records of 66 consecutive patients with AGC enrolled in phase I trials between March 2008 and July 2014 at our institution in Japan. Results Median age was 66 years (range, 28–78 years) and median number of previous lines of conventional chemotherapy was 3 (range, 1–6). Five (8.6 %) and seven (12 %) patients showed objective response and stable disease >3 months, respectively. Although the time to treatment failure (TTF) of the best phase I treatment was shorter than that of the last line of conventional chemotherapy (median 1.5 vs. 2.3 months; P = 0.002), TTF of the best phase I treatment was longer than that of the last line of treatment in 21 patients (32 %). Severe adverse events and grade 3 or higher toxicities were reported in eight (12 %) and 13 patients (20 %), respectively. No treatment-related death was observed. Median survival time from the start of phase I treatment was 7.5 months, and four deaths (6 %) within 30 days after last administration were observed. Conclusion Phase I trials of patients with AGC was acceptably feasible with some efficacy signal. Our results suggest that phase I trials might be one treatment option for patients with AGC when conventional therapies fail.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. International Agency for Research on Cancer. GLOBOCAN 2012: http://www-dep.iarc.fr/CancerMondial.htm

  2. Van Cutsem E, Moiseyenko VM, Tjulandin S et al (2006) Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 study group. J Clin Oncol 24:4991–4997

    Article  PubMed  Google Scholar 

  3. Kang YK, Kang WK, Shin DB et al (2009) Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol 20:666–673

    Article  PubMed  Google Scholar 

  4. Ajani JA, Rodriguez W, Bodoky G et al (2010) Multicenter phase III comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study: the FLAGS trial. J Clin Oncol 28:1547–1553

    Article  CAS  PubMed  Google Scholar 

  5. Cunningham D, Starling N, Rao S et al (2008) Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 358:36–46

    Article  CAS  PubMed  Google Scholar 

  6. Boku N, Yamamoto S, Fukuda H et al (2009) Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 10:1063–1069

    Article  CAS  PubMed  Google Scholar 

  7. Koizumi W, Narahara H, Hara T et al (2008) S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 9:215–221

    Article  CAS  PubMed  Google Scholar 

  8. Ohtsu A, Shah MA, Van Cutsem E et al (2011) Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebo-controlled phase III study. J Clin Oncol 29:3968–3976

    Article  CAS  PubMed  Google Scholar 

  9. Bang YJ, Van Cutsem E, Feyereislova A et al (2010) Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 376:687–697

    Article  CAS  PubMed  Google Scholar 

  10. Fuchs CS, Tomasek J, Yong CJ et al (2014) Ramucirumab monotherapy for previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (REGARD): an international, randomised, multicentre, placebo-controlled, phase 3 trial. Lancet 383:31–39

    Article  CAS  PubMed  Google Scholar 

  11. Wilke H, Muro K, Van Cutsem E et al (2014) Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol 15:1224–1235

    Article  CAS  PubMed  Google Scholar 

  12. Agrawal M, Emanuel EJ (2003) Ethics of phase 1 oncology studies: reexamining the arguments and data. JAMA 290:1075–1082

    Article  PubMed  Google Scholar 

  13. Horstmann E, McCabe MS, Grochow L et al (2005) Risks and benefits of phase 1 oncology trials, 1991 through 2002. N Engl J Med 352:895–904

    Article  CAS  PubMed  Google Scholar 

  14. Bachelot T, Ray-Coquard I, Catimel G et al (2000) Multivariable analysis of prognostic factors for toxicity and survival for patients enrolled in phase I clinical trials. Ann Oncol 11:151–156

    Article  CAS  PubMed  Google Scholar 

  15. Gupta S, Hunsberger S, Boerner SA et al (2012) Meta-analysis of the relationship between dose and benefit in phase I targeted agent trials. J Natl Cancer Inst 104:1860–1866

    Article  CAS  PubMed  Google Scholar 

  16. Han C, Braybrooke JP, Deplanque G et al (2003) Comparison of prognostic factors in patients in phase I trials of cytotoxic drugs vs new noncytotoxic agents. Br J Cancer 89:1166–1171

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Roberts TG Jr, Goulart BH, Squitieri L et al (2004) Trends in the risks and benefits to patients with cancer participating in phase 1 clinical trials. JAMA 292:2130–2140

    Article  CAS  PubMed  Google Scholar 

  18. Jain RK, Lee JJ, Ng C et al (2012) Change in tumor size by RECIST correlates linearly with overall survival in phase I oncology studies. J Clin Oncol 30:2684–2690

    Article  PubMed Central  PubMed  Google Scholar 

  19. Garrido-Laguna I, Janku F, Falchook GS et al (2010) Patients with advanced head and neck cancers have similar progression-free survival on phase I trials and their last food and drug administration-approved treatment. Clin Cancer Res 16:4031–4037

    Article  CAS  PubMed  Google Scholar 

  20. Tsimberidou AM, Vaklavas C, Wen S et al (2009) Phase I clinical trials in 56 patients with thyroid cancer: the M. D. Anderson Cancer Center experience. J Clin Endocrinol Metab 94:4423–4432

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Topalian SL, Sznol M, McDermott DF et al (2014) Survival, durable tumor remission, and long-term safety in patients with advanced melanoma receiving nivolumab. J Clin Oncol 32:1020–1030

    Article  CAS  PubMed  Google Scholar 

  22. Cassier PA, Polivka V, Judson I et al (2014) Outcome of patients with sarcoma and other mesenchymal tumours participating in phase I trials: a subset analysis of a European Phase I database. Ann Oncol 25:1222–1228

    Article  CAS  PubMed  Google Scholar 

  23. Khan K, Ang JE, Starling N et al (2014) Phase I trials in patients with relapsed, advanced upper gastrointestinal carcinomas: experience in a specialist unit. Gastric Cancer 17:621–629

    Article  CAS  PubMed  Google Scholar 

  24. Hong DS, Patel JC, Wheler J et al (2012) Outcomes in 144 patients with colorectal cancer treated in a phase I clinic: the MD Anderson Cancer Center experience. Clin Colorectal Cancer 11:297–303

    Article  PubMed  Google Scholar 

  25. Chapman PB, Hauschild A, Robert C et al (2011) Improved survival with vemurafenib in melanoma with BRAF V600E mutation. N Engl J Med 364:2507–2516

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Kwak EL, Bang YJ, Camidge DR et al (2010) Anaplastic lymphoma kinase inhibition in non-small-cell lung cancer. N Engl J Med 363:1693–1703

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  27. Brahmer JR, Tykodi SS, Chow LQ et al (2012) Safety and activity of anti-PD-L1 antibody in patients with advanced cancer. N Engl J Med 366:2455–2465

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  28. Topalian SL, Hodi FS, Brahmer JR et al (2012) Safety, activity, and immune correlates of anti-PD-1 antibody in cancer. N Engl J Med 366:2443–2454

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Muro K, Bang Y, Shankaran V, Geva R et al (2014) A phase 1b study of pembrolizumab (Pembro; MK-3475) in patients (Pts) with advanced gastric cancer. Ann Oncol 25:1–41

    Article  Google Scholar 

  30. Cancer Genome Atlas Research Network (2014) Comprehensive molecular characterization of gastric adenocarcinoma. Nature 513:202–209

    Article  Google Scholar 

  31. Garraway LA (2013) Genomics-driven oncology: framework for an emerging paradigm. J Clin Oncol 31:1806–1814

    Article  PubMed  Google Scholar 

  32. Tsimberidou AM, Iskander NG, Hong DS et al (2012) Personalized medicine in a phase I clinical trials program: the MD Anderson Cancer Center initiative. Clin Cancer Res 18:6373–6383

    Article  CAS  PubMed  Google Scholar 

  33. Tsimberidou AM, Wen S, Hong DS et al (2014) Personalized medicine for patients with advanced cancer in the phase I program at MD Anderson: validation and landmark analyses. Clin Cancer Res 20:4827–4836

    Article  CAS  PubMed  Google Scholar 

  34. Deng N, Goh LK, Wang H et al (2012) A comprehensive survey of genomic alterations in gastric cancer reveals systematic patterns of molecular exclusivity and co-occurrence among distinct therapeutic targets. Gut 61:673–684

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  35. Nagatsuma AK, Aizawa M, Kuwata T et al (2014) Expression profiles of HER2, EGFR, MET and FGFR2 in a large cohort of patients with gastric adenocarcinoma. Gastric Cancer. doi:10.1007/s10120-014-0360-4

  36. Anderson JR, Cain KC, Gelber RD (1983) Analysis of survival by tumor response. J Clin Oncol 1:710–719

    CAS  PubMed  Google Scholar 

Download references

Conflict of interest

The authors declare no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Kohei Shitara.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Kawazoe, A., Shitara, K., Fukuoka, S. et al. Clinical outcomes in 66 patients with advanced gastric cancer treated in phase I trials: the NCCHE experience. Invest New Drugs 33, 664–670 (2015). https://doi.org/10.1007/s10637-015-0231-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10637-015-0231-9

Keywords

Navigation