Walden Daniel, Sonbol Mohamad Bassam, Buckner Petty Skye, Yoon Harry H, Borad Mitesh, Bekaii-Saab Tanios S, Ahn Daniel H
Department of Medical Oncology, Mayo Clinic Cancer Center, Phoenix, AZ, United States.
Department of Medical Oncology, Mayo Clinic Cancer Center, Rochester, MN, United States.
Front Oncol. 2021 Sep 10;11:641044. doi: 10.3389/fonc.2021.641044. eCollection 2021.
Fluoropyrimidine with platinum-based chemotherapy has become the standard of care for advanced gastric and gastroesophageal (GEJ) cancer. Trials in colon cancer show that induction chemotherapy followed by maintenance chemotherapy is an efficacious strategy to maximize clinical response while minimizing toxicity. The current retrospective study aims to evaluate the efficacy and tolerability of maintenance versus continuous treatment in advanced GEJ malignancy.
A retrospective analysis of patients with metastatic gastric/GEJ adenocarcinoma treated with fluoropyrimidine and platinum chemotherapy between 2007-2017 was performed. Patients who achieved at least stable disease after initial induction treatment were included. After 16 weeks of induction chemotherapy, patients were categorized into the continuous group if induction chemotherapy was continued and the maintenance group if chemotherapy was switched to maintenance fluoropyrimidine monotherapy or observed off treatment. Endpoints were progression-free survival (PFS), overall survival (OS), and toxicities.
In total, 90 patients met the criteria, 48 received continuous therapy, and 42 received maintenance. Baseline characteristics were comparable. No difference in PFS (9.9 8.4 months p = .28) or in OS (16.1 21.3 months p = .75) was observed, including after controlling for the best response on induction therapy and other variables. In patients on continuous induction therapy, there was a higher prevalence of grade three neuropathy (42.6% 9.8% p = .001) and neutropenic fever (13% 0% p =.03).
Maintenance therapy following induction fluoropyrimidine and platinum-based therapy is associated with an improved toxicity profile and appears to have comparable efficacy to continuous treatment in metastatic gastric/GEJ cancer.
氟尿嘧啶联合铂类化疗已成为晚期胃癌和胃食管交界（GEJ）癌的标准治疗方案。结肠癌试验表明，诱导化疗后进行维持化疗是一种有效的策略，可在将毒性降至最低的同时使临床反应最大化。本项回顾性研究旨在评估晚期GEJ恶性肿瘤维持治疗与持续治疗的疗效和耐受性。
对2007年至2017年间接受氟尿嘧啶和铂类化疗的转移性胃/GEJ腺癌患者进行回顾性分析。纳入在初始诱导治疗后至少达到疾病稳定的患者。诱导化疗16周后，如果继续进行诱导化疗，则患者被归入持续治疗组；如果化疗改为维持氟尿嘧啶单药治疗或停止治疗观察，则患者被归入维持治疗组。观察终点为无进展生存期（PFS）、总生存期（OS）和毒性反应。
共有90例患者符合标准，48例接受持续治疗，42例接受维持治疗。基线特征具有可比性。未观察到PFS（9.9对8.4个月，p = 0.28）或OS（16.1对21.3个月，p = 0.75）存在差异，包括在控制诱导治疗的最佳反应和其他变量后。在持续诱导治疗的患者中，3级神经病变（42.6%对9.8%，p = 0.001）和中性粒细胞减少性发热（13%对0%，p = 0.03）的发生率更高。
诱导氟尿嘧啶和铂类治疗后的维持治疗与毒性反应改善相关，并且在转移性胃/GEJ癌中似乎与持续治疗具有相当的疗效。
