Cancer Res Treat.  2011 Dec;43(4):236-243.

Prognostic Factors of Second and Third Line Chemotherapy Using 5-FU with Platinum, Irinotecan, and Taxane for Advanced Gastric Cancer

• Park JS
• Lim JY
• Park SK
• Kim MK
• Ko HS
• Yoon SO
• Kim JW
• Choi SH
• Cho JY

Abstract

PURPOSE
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.
MATERIALS AND 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.
CONCLUSION
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.

Keyword

Stomach neoplasms; Salvage therapy; Prognosis; Oxaliplatin; Irinotecan; Taxane

MeSH Terms

Arm
Bridged Compounds
Camptothecin
Epirubicin
Fluorouracil
Humans
Leucovorin
Organoplatinum Compounds
Paclitaxel
Platinum
Prognosis
Salvage Therapy
Stomach Neoplasms
Taxoids
Thymine Nucleotides
Transcriptome
Bridged Compounds
Camptothecin
Epirubicin
Fluorouracil
Leucovorin
Organoplatinum Compounds
Paclitaxel
Platinum
Taxoids
Thymine Nucleotides

Figure

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  Fig. 1 Overall survival by treatment Arm.

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  Fig. 2 Overall survival by response to chemotherapy.

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