Digestive Cancer Registry of Burgundy, INSERM, LNC UMR1231, University Bourgogne Franche-Comté, Dijon-Bourgogne University Hospital, Dijon, France.
University Hospital Cochin, Paris, France.
Cancer Med. 2023 Mar;12(5):5341-5351. doi: 10.1002/cam4.5354. Epub 2022 Nov 16.
Around 50% of gastric cancers are diagnosed at an advanced stage. Several chemotherapy regimens are now internationally validated. Few data are available on the routine daily management of advanced gastric or gastroesophageal junction cancers. We aimed to describe chemotherapy practices, tolerance, and efficacy overall survival (OS) and Progression free survival (PFS) in a prospective French cohort.
Patients starting palliative chemotherapy were prospectively enrolled in 49 French centres. The primary objective was to report and describe patients' characteristics and treatment strategies. Secondary objectives were OS, PFS, objective response rate, adverse events rate, performance status deterioration during the chemotherapy.
A total of 182 patients were included; 179 were analysed. Most patients received platinium-based chemotherapy as the first treatment and FOLFIRI as second; 62.0% of patients received a second line, and 32.4% a third line. More than two thirds of Her2-positive patients were first treated with trastuzumab. The FOLFIRI regimen was the most frequently used second-line therapy. Median OS was 13.3 months, similar whatever the chemotherapy or combinations used in the first line. One- and 2-year OS increased with the number of chemotherapy lines received, from respectively 24.7% and 5.7% (1 line), to 46.9% and 12.4% (2 lines) and 88.1% and 29.9% (3 or more lines) (p < 0.0001).
Our study showed that treatment strategies in France are based on a succession of doublets, making it possible to offer a second and third line of treatment more often. This treatment strategy must be taken into account for future trials with immunotherapy combinations.
约 50%的胃癌患者在晚期被诊断出来。目前有几种化疗方案在国际上得到验证。关于晚期胃癌或胃食管交界处癌的常规日常管理数据很少。我们旨在描述在法国前瞻性队列中化疗的实践、耐受性和疗效，包括总生存期（OS）和无进展生存期（PFS）。
49 个法国中心前瞻性地招募开始姑息性化疗的患者。主要目的是报告和描述患者的特征和治疗策略。次要目标是 OS、PFS、客观缓解率、不良事件发生率、化疗期间的体能状态恶化。
共纳入 182 例患者，179 例进行了分析。大多数患者接受铂类化疗作为一线治疗，FOLFIRI 作为二线治疗；62.0%的患者接受二线治疗，32.4%的患者接受三线治疗。超过三分之二的 Her2 阳性患者首先接受曲妥珠单抗治疗。FOLFIRI 方案是最常用的二线治疗方案。中位 OS 为 13.3 个月，与一线使用的化疗或联合方案无关。随着接受化疗线数的增加，1 年和 2 年的 OS 增加，分别从 24.7%和 5.7%（1 线）增加到 46.9%和 12.4%（2 线）和 88.1%和 29.9%（3 线或更多线）（p<0.0001）。
我们的研究表明，法国的治疗策略基于一系列的双药联合方案，使二线和三线治疗成为可能。这种治疗策略必须在未来的免疫治疗联合试验中考虑。
