Medical Oncology Department, Hospital General Universitario de Elda, Alicante, Spain.
Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain.
PLoS One. 2020 Jul 31;15(7):e0235848. doi: 10.1371/journal.pone.0235848. eCollection 2020.
Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice.
The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS).
2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9-3.3) and 5.8 months (5.5-6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall's τ = 0.613), lower in those subjects who received second-line (Kendall's τ = 0.539), especially with ramucirumab+CT (Kendall's τ = 0.413).
This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.
二线治疗可提高晚期胃癌（AGC）的总生存期。然而，在实际临床实践中，二线治疗的使用模式和结果信息仍然匮乏。
AGAMENON 登记处的 AGC 患者接受了二线治疗，本研究纳入了该人群。目的是描述二线治疗的模式、二线治疗后的无进展生存期（PFS-2）和一线治疗后的进展后生存期（PPS）。
记录了 2311 例患者，其中 2066 例患者（89.3%）在一线治疗后出现进展事件；245 例（10.6%）患者在一线治疗期间死亡，1326/2066 例（64.1%）接受了二线治疗。中位 PFS-2 和 PPS 分别为 3.1 个月（95%CI，2.9-3.3）和 5.8 个月（5.5-6.3）。最广泛使用的策略是单药化疗（56.9%）、多药化疗（15.0%）、雷莫芦单抗+化疗（12.6%）、铂类药物重新引入（8.3%）、曲妥珠单抗+化疗（6.1%）和雷莫芦单抗（1.1%）。PFS-2/PPS 中位数在单药化疗中逐渐增加，分别为 2.6/5.1 个月；多药化疗为 3.4/6.3 个月；雷莫芦单抗+化疗为 4.1/6.5 个月；铂类药物重新引入为 4.2/6.7 个月，特别是对于 HER2+亚组，曲妥珠单抗+化疗为 5.2/11.7 个月。整个系列中，PFS-2 与 OS 之间的相关性为中等（Kendall's τ=0.613），在接受二线治疗的患者中相关性较低（Kendall's τ=0.539），尤其是雷莫芦单抗+化疗（Kendall's τ=0.413）。
本分析揭示了 AGC 二线治疗的多样性，突出了紫杉醇-雷莫芦单抗的有效性，对于特定的亚组患者，铂类药物重新引入也是有效的；这两种策略都得到了最新临床指南的认可。
