Metastatic gastric cancer: frontline doublets offer similar OS

  • Kim C & al.
  • Eur J Cancer
  • 19 Mar 2019

  • curated by Jim Kling
  • Univadis Clinical Summaries
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Takeaway

  • S-1 and cisplatin (SP), oxaliplatin and 5-FU (FOLFOX), docetaxel and 5-FU (DF), and paclitaxel and 5-FU (PF) led to similar OS in Korean patients with metastatic gastric cancer.
  • SP treatment was associated with longer progression-free survival (PFS), but the benefit was partially attenuated by subsequent chemotherapies.

Why this matters

  • Given that ramucirumab and paclitaxel is the most effective second-line treatment, FOLFOX may be the most reasonable choice for first-line therapy.

Study design

  • Randomized, controlled phase 2 trial (n=177). The study was terminated early because of slow accrual.
  • Funding: Nonindustry sources.

Key results

  • Median PFS was longest with SP (8.4 months) compared with FOLFOX (5.8 months), DF (5.7 months), and PF (4.2 months; P=.023).
  • There was no difference between regimens in median OS.
  • SP and FOLFOX grouped together (platinum group) trended toward longer PFS (7.2 vs 4.9 months; P=.058), but OS was similar (13.3 vs 11.7 months; P=.431).
  • Among patients exposed to all 3 drugs (platinum, taxane, and fluoropyrimidine), OS was similar, whether platinum or taxane was the first exposure.
  • First-line platinum treatment led to better PFS in patients with intestinal-type gastric cancer (HR, 0.28; P=.005) and those free of peritoneal metastasis at diagnosis (HR, 0.52; P=.03).

Limitations

  • Early termination.
  • Asian population.

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