Ishii Takahiro, Kawazoe Akihito, Sasaki Akinori, Mishima Saori, Kentaro Sawada, Nakamura Yoshiaki, Kotani Daisuke, Kuboki Yasutoshi, Taniguchi Hiroya, Kojima Takashi, Doi Toshihiko, Yoshino Takayuki, Kuwata Takeshi, Ishii Genichiro, Shitara Kohei
Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Department of Pathology and Clinical Laboratories, National Cancer Center Hospital East, Kashiwa, Chiba, Japan.
Ther Adv Med Oncol. 2020 Jul 17;12:1758835920942377. doi: 10.1177/1758835920942377. eCollection 2020.
The use of nivolumab or irinotecan as the third-line treatment for patients with advanced gastric cancer (AGC) remains controversial.
This study analyzed patients with AGC treated with nivolumab or irinotecan (nivolumab group or irinotecan group, respectively) from May 2016 to April 2019 following two or more previous lines of chemotherapy. Univariate survival analysis was conducted to identify the clinical and molecular factors associated with progression-free survival (PFS).
A total of 156 patients (74 treated with nivolumab and 82 treated with irinotecan) were analyzed. The median PFS was 1.9 months in both treatment groups. The median overall survival (OS) was 7.2 and 6.2 months in the nivolumab and irinotecan groups, respectively. Eastern Cooperative Oncology Group performance status of 1 or more, liver metastasis, a large tumor size at baseline, and HER2-positive status were associated with a worse PFS in the nivolumab group compared with the irinotecan group. The nivolumab group showed a significantly longer PFS (median 3.1 2.0 months) and OS (median 12.9 7.8 months) than the irinotecan group in patients with 0 or 1 of these factors, whereas the irinotecan group showed a significantly longer PFS (median 1.0 1.8 months) and a trend of longer OS (median 3.9 6.1 months) in patients with ⩾2 of these factors.
Some clinical and molecular factors were associated with outcomes following nivolumab or irinotecan as the third- or later-line treatment in patients with AGC. These factors must be considered while selecting an optimal treatment option.
纳武利尤单抗或伊立替康作为晚期胃癌（AGC）患者的三线治疗方案，其应用仍存在争议。
本研究分析了2016年5月至2019年4月接受过两种或更多线先前化疗后接受纳武利尤单抗或伊立替康治疗的AGC患者（分别为纳武利尤单抗组或伊立替康组）。进行单因素生存分析以确定与无进展生存期（PFS）相关的临床和分子因素。
共分析了156例患者（74例接受纳武利尤单抗治疗，82例接受伊立替康治疗）。两个治疗组的中位PFS均为1.9个月。纳武利尤单抗组和伊立替康组的中位总生存期（OS）分别为7.2个月和6.2个月。与伊立替康组相比，东部肿瘤协作组体能状态评分为1分或更高、肝转移、基线时肿瘤体积大以及HER2阳性状态与纳武利尤单抗组更差的PFS相关。在具有这些因素中的0个或1个因素的患者中，纳武利尤单抗组的PFS（中位3.1对2.0个月）和OS（中位12.9对7.8个月）显著长于伊立替康组，而在具有这些因素中的≥2个因素的患者中，伊立替康组的PFS（中位1.0对1.8个月）显著更长且OS有延长趋势（中位3.9对6.1个月）。
一些临床和分子因素与AGC患者接受纳武利尤单抗或伊立替康作为三线或更后线治疗后的结局相关。在选择最佳治疗方案时必须考虑这些因素。
