Cancer Res Treat.  2016 Apr;48(2):553-560. 10.4143/crt.2015.155.

A Retrospective Analysis for Patients with HER2-Positive Gastric Cancer Who Were Treated with Trastuzumab-Based Chemotherapy: In the Perspectives of Ethnicity and Histology

• Yi JH
• Kang JH
• Hwang IG
• Ahn HK
• Baek HJ
• Lee SI
• Lim DH
• Won YW
• Ji JH
• Kim HS
• Rha SY
• Oh SY
• Lee KE
• Lim T
• Maeng CH
• Kim MJ
• Kim ST
• Lee J
• Park JO
• Park YS
• Lim HY
• Kang WK
• Park SH

• KMID: 2454332
• DOI: http://doi.org/10.4143/crt.2015.155

Abstract

PURPOSE
While the Trastuzumab for Gastric Cancer (ToGA) trial demonstrated the efficacy and safety of trastuzumab-based chemotherapy in HER2-positive metastatic gastric cancer, the overall survival (OS) benefit was not found in Asian and diffuse-type cancer patients. The aim of the study is to investigate predictive markers for trastuzumab-based chemotherapy.
MATERIALS AND METHODS
Data of patients with HER2-positive gastric cancer treated with trastuzumab-based chemotherapy were analyzed retrospectively.
RESULTS
A total of 168 Asian patients were included. The median age was 60 years (range, 27 to 85 years) and the male:female ratio was 118 (70.2%):50 (29.8%). Fourteen (8.3%), 63 (37.5%), 75 (44.6%), and 11 (6.5%) patients had well, moderately, poorly-differentiated tubular adenocarcinoma and signet ring cell carcinoma, respectively. With 14 complete responses and 73 partial responses, the response rate was 50.6%. The median progression-free survival (PFS) was 10.2 months (95% confidence interval [CI], 8.7 to 11.7), and the median OS was 18.5 months (95% CI, 16.4 to 50.6). Next, we investigated the effect of poorly-differentiated histology (PDH, poorly-differentiated tubular adenocarcinoma+signet ring cell carcinoma) on clinical outcomes. The median PFS (8.9 months vs. 11.5 months, p=0.16) was slightly inferior in PDH patients, and the median OS was significantly shorter in PDH patients (14.6 months vs. 19.0 months, p=0.025).
CONCLUSION
While subset analysis of the ToGA trial demonstrated that trastuzumab-based chemotherapy may not be beneficial for Asians and patients with PDH, our data may suggest that even in Asian patients and patients with PDH, trastuzumab-based chemotherapy could be associated with improved clinical outcomes in patients with HER2-positive gastric cancer.

Keyword

Stomach neoplasms; ErbB-2 receptor; Trastuzumab; Histology; Ethnic groups

MeSH Terms

Adenocarcinoma
Asian Continental Ancestry Group
Carcinoma, Signet Ring Cell
Disease-Free Survival
Drug Therapy*
Ethnic Groups
Humans
Receptor, ErbB-2
Retrospective Studies*
Stomach Neoplasms*
Trastuzumab
Receptor, ErbB-2
Trastuzumab

Figure

• 

  Fig. 1. Progression-free survival according to the histologic subtypes; 11.5 months (95% confidence interval [CI], 8.1 to 14.9) for patients with well-differentiated histology (WDH), and 8.9 months (95% CI, 7.2 to 10.6) for patients with poorly-differentiated histology (PDH).

• 

  Fig. 2. Overall survival according to the histologic subtypes; 19.0 months (95% confidence interval [CI], 14.2 to 23.8) for patients with well-differentiated histology (WDH), and 14.6 months (95% CI, 11.9 to 17.3) for patients with poorly-differentiated histology (PDH).

• 

  Fig. 3. Receiver operating characteristics (ROC) curves for identification of optimal cutoff values for favorable (6 months) progression-free survival. In this analysis, HER2/CEP17 ratio was not associated with favorable progression-free survival. AUC, area under the curve.

Reference

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