Prognostic Factors of Second and Third Line Chemotherapy Using 5-FU with Platinum, Irinotecan, and Taxane for Advanced Gastric Cancer
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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.
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.
참고문헌 (25)
- Jemal A, "Global cancer statistics", CA Cancer J Clin, 61, pp.69~90 (2011)
- 정규원, "Cancer Statistics in Korea: Incidence, Mortality, Survival, and Prevalence in 2008", Cancer Research and Treatment, 43(1), pp.1~11 (2011), 대한암학회
- Ajani JA, "Evolving chemotherapy for advanced gastric cancer", Oncologist, 10(3), pp.49~58 (2005)
- Wilson D, "Review of second-line chemotherapy for advanced gastric adenocarcinoma", Clin Oncol, 17, pp.81~90 (2005)
- Moon YW, "Outcomes of multiple salvage chemotherapy for advanced gastric cancer: implications for clinical practice and trial design", CANCER CHEMOTHERAPY AND PHARMACOLOGY, 66(4), pp.797~805 (2010), SPRINGER
- Jeong J, "Phase II study of combination chemotherapy of 5-fluorouracil, low-dose leucovorin, and oxaliplatin (FLOX regimen) in pretreated advanced gastric cancer", Annals Of Oncology, 19(6), pp.1135~1140 (2008)
- Glimelius B, "Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer", Ann Oncol, 8, pp.163~168 (1997)
- Ji SH, "A retrospective analysis of secondline chemotherapy in patients with advanced gastric cancer", BMC Cancer, 9, pp.110~ (2009)
- Kanagavel D, "A prognostic model in patients treated for metastatic gastric cancer with second-line chemotherapy", Ann Oncol, 21, pp.1779~1785 (2010)
- Jo JC, "Docetaxel monotherapy as a second- line treatment after failure of fluoropyrimidine and platinum in advanced gastric cancer: experience of 154 patients with prognostic factor analysis", Jpn J Clin Oncol, 37, pp.936~941 (2007)
- Satoh S, "Retrospective evaluation of sequential outpatient chemotherapy for advanced gastric cancer", Chemotherapy, 53, pp.226~232 (2007)
- "Irinotecan combined with 5-fluorouracil and leucovorin as second-line chemotherapy for metastatic or relapsed gastric cancer", JAPANESE JOURNAL OF CLINICAL ONCOLOGY, 38(9), pp.589~595
- Kim SH, "A Phase II Study of Irinotecan, Continuous 5-Fluorouracil, and Leucovorin (FOLFIRI) Combination Chemotherapy for Patients With Recurrent or Metastatic Gastric Cancer Previously Treated With a Fluoropyrimidine-Based Regimen", AMERICAN JOURNAL OF CLINICAL ONCOLOGY-CANCER CLINICAL TRIALS, 33, pp.572~576 (2010), American Journal of Clinical Onoclogy
- Takiuchi H, "Multi-center phase II study for combination therapy with paclitaxel", doxifluridine to treat advanced, Jpn J Clin Oncol, pp.2008, 38[DOI]
- Kim JA, "Docetaxel", cisplatin followed by FOLFIRI versus the reverse sequence in metastatic gastric cancer, 2011, pp.68, 177~184
- Shim HJ, "Prognostic factor analysis of thirdline chemotherapy in patients with advanced gastric cancer", Gastric Cancer, 14, pp.249~256 (2011)
- Catalano V, "Second-line chemotherapy for patients with advanced gastric cancer: who may benefit", Br J Cancer, 99, pp.1402~1407 (2008)
- Piessen G, "Signet ring cell histology is an independent predictor of poor prognosis in gastric adenocarcinoma regardless of tumoral clinical presentation", Ann Surg, 250, pp.878~887 (2009)
- Hyung WJ, "Early gastric carcinoma with signet ring cell histology", Cancer, 94, pp.78~83 (2002)
- Zhang YH, "Carcinoembryonic antigen level is related to tumor invasion into the serosa of the stomach: study on 166 cases and suggestion for new therapy", Hepatogastroenterology, 56, pp.1750~1754 (2009)
- Seong-Hoon Park, "Prognostic Significance of Serum and Tissue Carcinoembryonic Antigen in Patients with Gastric Adenocarcinomas", Cancer Research and Treatment, 40(1), pp.16~21 (2008), 대한암학회
- Shah MA, "Molecular classification of gastric cancer: a new paradigm", Clin Cancer Res, 17, pp.2693~2701 (2011)
- Ueda K, "Carcinoembryonic antigen-specific suicide gene therapy of cytosine deaminase", 5-fluorocytosine enhanced by the cre, Cancer Res, pp.2001, 61[DOI]
- Toffoli G, "Clinical implications of genetic polymorphisms on stomach cancer drug therapy", Pharmacogenomics J, 7, pp.76~80 (2007)
- Golub TR, "Molecular classification of cancer: class discovery and class prediction by gene expression monitoring", Science, 286, pp.531~537 (1999)