Toward a Treatment Sequencing Strategy: A Systematic Review of Treatment Regimens in Advanced Gastric Cancer/Gastroesophageal Junction Adenocarcinoma.

Autor: Catenacci DV; University of Chicago Medical Center & Biological Sciences, Chicago, Illinois, USA., Chao J; City of Hope Comprehensive Cancer Center, Duarte, California, USA., Muro K; Aichi Cancer Center Hospital, Nagoya, Japan., Al-Batran SE; Institute of Clinical Cancer Research Krankenhaus Nordwest, Frankfurt, Germany., Klempner SJ; Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA., Wainberg ZA; UCLA Santa Monica Medical Center, Santa Monica, California, USA., Shah MA; Weill Cornell Medicine, New York, New York, USA., Rha SY; Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea., Ohtsu A; National Cancer Center Hospital East, Chiba, Japan., Liepa AM; Eli Lilly & Co, Indianapolis, Indiana, USA., Knoderer H; Eli Lilly & Co, Indianapolis, Indiana, USA., Chatterjee A; Eli Lilly & Co, Indianapolis, Indiana, USA., Van Cutsem E; Digestive Oncology, University Hospitals Gasthuisberg Leuven and KU Leuven, Leuven, Belgium.
Jazyk: angličtina
Zdroj: The oncologist [Oncologist] 2021 Oct; Vol. 26 (10), pp. e1704-e1729. Date of Electronic Publication: 2021 Sep 03.
DOI: 10.1002/onco.13907
Abstrakt: Background: Platinum and fluoropyrimidine combinations typically comprise first-line (1L) therapy in advanced gastric cancer or gastroesophageal junction adenocarcinoma (G/GEA), although controversy exists regarding the use of 5doublet versus triplet cytotoxic regimens. Historically, second-line (2L) and third-line or later (3L+) therapy has been fragmented. Recent trials have increased the need for optimal treatment sequencing in advanced G/GEA.
Materials and Methods: We conducted a systematic search of peer-reviewed manuscripts of randomized clinical trials examining 1L, 2L, and 3L+ therapy for advanced G/GEA published from 2009 through November 19, 2019. When available, overall survival, progression-free survival, time to progression, overall response rate, and toxicity were extracted from each and compared descriptively.
Results: In 1L therapy, chemotherapy triplets demonstrated variable efficacy improvements with invariable increased toxicity compared with platinum/fluoropyrimidine doublets. Currently, the only published report of positive outcomes using biologics in 1L describes adding trastuzumab in HER2-overexpressing advanced G/GEA. In 2L, doublet chemotherapy regimens are not uniformly more efficacious than single-agent taxanes or irinotecan, and ramucirumab has demonstrated improved outcomes both as monotherapy and in combination.
Conclusion: For advanced G/GEA, review of trial results from 2009-2019 support 1L therapy with platinum and fluoropyrimidine and sequencing with taxanes or irinotecan in combination with biologics as effective 2L options. Escalating to a triplet may add some efficacy at the expense of added toxicity.
Implications for Practice: The rapidly changing treatment landscape for advanced gastric cancer includes increasing options for refractory disease. With multiple first-line platinum-based regimens, identification of those with the best benefit-to-risk ratio may provide guidance on treatment sequencing strategies. This article presents findings from the published literature of randomized controlled trials that included a first-line platinum/fluoropyrimidine combination and, for second-line trials, patients with platinum/fluoropyrimidine-refractory disease. This guiding summary could be a tool for clinicians to identify the optimal first-line regimen(s) followed by a strategy for subsequent regimens.
(© 2021 ELI LILLY AND COMPANY. The Oncologist published by Wiley Periodicals LLC on behalf of AlphaMed Press.)
Databáze: MEDLINE
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