Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
Department of Medical Oncology, Toranomon Hospital, Toranomon, Minato-ku, Tokyo, Japan.
Gastric Cancer. 2018 Nov;21(6):1050-1057. doi: 10.1007/s10120-018-0825-y. Epub 2018 Apr 16.
Although nivolumab showed survival benefit in patients with advanced gastric cancer (AGC) progressing after standard chemotherapy, there is a lack of data regarding oxaliplatin-based chemotherapy in this clinical setting.
We retrospectively evaluated the efficacy and safety of oxaliplatin with l-leucovorin and bolus/continuous infusion of 5-fluorouracil as salvage treatment in patients with AGC refractory or intolerant to fluoropyrimidines, cisplatin, taxanes, and irinotecan.
Overall, 50 patients treated between December 2009 and December 2013 were included in this analysis. The overall response rate (ORR) was 21.2% among 33 patients with measurable disease. The median time to treatment failure (TTF) and overall survival (OS) were 2.4 and 4.2 months. In multivariate analysis, factors associated with OS included poor performance status [hazard ratio (HR) 3.20; 95% confidence interval (CI) 1.55-6.60], shorter time from the start of first-line therapy (HR 2.20; 95% CI 1.18-4.12), and higher neutrophil/lymphocyte ratio value (HR 4.87; 95% CI 2.32-10.25). In patients (n = 35) with at most one risk factor, the ORR, median TTF, and OS were 26.1%, 3.6, and 6.7 months, respectively. The most common grade 3 or 4 adverse events were neutropenia (30%), anemia (22%), febrile neutropenia (8%), and peripheral neuropathy (8%). Initial and subsequent dose reduction was performed in 18 (36%) and 23 (46%) patients. There was one treatment-related death caused by septic infection.
Salvage chemotherapy with the combination of oxaliplatin, leucovorin, and 5-fluorouracil has a potential activity and is tolerable for heavily treated AGC with appropriate dose modification and patient selection.
纳武利尤单抗在标准化疗后进展的晚期胃癌（AGC）患者中显示出生存获益，但在这种临床环境下，奥沙利铂为基础的化疗数据缺乏。
我们回顾性评估了奥沙利铂联合左亚叶酸钙和氟尿嘧啶推注/持续输注作为氟嘧啶类药物、顺铂、紫杉烷类和伊立替康耐药或不耐受的 AGC 患者的挽救治疗的疗效和安全性。
共有 50 例患者在 2009 年 12 月至 2013 年 12 月期间接受了治疗，这些患者纳入了本分析。33 例可测量疾病患者的总缓解率（ORR）为 21.2%。中位无进展生存期（TTP）和总生存期（OS）分别为 2.4 和 4.2 个月。多变量分析中，与 OS 相关的因素包括较差的体能状态[风险比（HR）3.20；95%置信区间（CI）1.55-6.60]、从一线治疗开始的时间较短（HR 2.20；95%CI 1.18-4.12）和较高的中性粒细胞/淋巴细胞比值（HR 4.87；95%CI 2.32-10.25）。在（n=35）仅有一个危险因素的患者中，ORR、中位 TTF 和 OS 分别为 26.1%、3.6 和 6.7 个月。最常见的 3 级或 4 级不良事件是中性粒细胞减少（30%）、贫血（22%）、发热性中性粒细胞减少（8%）和周围神经病变（8%）。18 例（36%）和 23 例（46%）患者进行了初始和后续剂量减少。有一例治疗相关死亡是由感染引起的。
奥沙利铂、亚叶酸钙和氟尿嘧啶联合挽救化疗对经过适当剂量调整和患者选择的大量治疗后的 AGC 具有潜在的活性和可耐受性。
