Abstract
The best choice of chemotherapy regimen for patients with metastatic gastric cancer is still debated. Although several studies support a superior efficacy of a triplet chemotherapy regimen over a doublet-based regimen, the magnitude of this benefit appears small and accompanied by an increased toxicity. Based on this background, we evaluated the outcome of patients with HER2-negative metastatic gastric cancer (mGC) who received in the clinical practice a triplet or doublet regimen as first-line therapy. A total of 165 patients (pts) with HER2-negative mGC treated outside of clinical trials at our department with FOLFOX-4 or ECX from 2012 and 2015 were included in our retrospective analysis: FOLFOX-4: 86 pts; ECX: 79 pts. Median progression-free survival (PFS) was 5.1 months for FOLFOX-4 and 5.6 months for ECX regimen, respectively. Median overall survival (OS) was 10.3 months for FOLFOX-4 and 10.9 months for ECX regimens. Toxicity: grade 3–4 vomiting (12.6%), neutropenia (31.6%), mucositis (11.3%) and fatigue (22.7%) occurred more frequently in ECX regimen, while grade 3–4 peripheral neuropathy was more common with FOLFOX-4 (19.7%). Both evaluated regimens are active and safe in the palliation of HER2-negative mGC in the first-line setting: Three-drug chemotherapy regimen appear more active but offer only a slight improvement in OS with an increased G3–G4 toxicity. Our data suggest that a doublet therapy should be preferred in the clinical practice, preferentially reserving a three-drug combination to pts with bulky disease and/or to pts with initially unresectable locally advanced disease.
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MML, LP and FDV contributed to conception and design, acquisition, analysis and interpretation of data and writing the manuscript. AP, GT, AP, NDM, MO, TT contributed to conception and design, acquisition, analysis and interpretation of data and revising the manuscript. FC and FDV contributed to revising the manuscript, final approval of the final version to be published. All authors read and approved the final manuscript.
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Authors MML, LP, AP, GT, AP, MO, TT, FC, NDM and FDV declare that they have no conflict of interests.
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All patients, at the time of therapy, signed informed consent about the use of their data for future medical research. The analysis was carried out with the approval of the Ethical Committee of AOU Università della Campania “Luigi Vanvitelli,” of our institution.
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Laterza, M.M., Pompella, L., Petrillo, A. et al. Efficacy of a triplet and doublet-based chemotherapy as first-line therapy in patients with HER2-negative metastatic gastric cancer: a retrospective analysis from the clinical practice. Med Oncol 34, 186 (2017). https://doi.org/10.1007/s12032-017-1046-7
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DOI: https://doi.org/10.1007/s12032-017-1046-7