Kamiimabeppu Daisaku, Wakatsuki Takeru, Takahari Daisuke, Fukuda Naoki, Shimozaki Keitaro, Osumi Hiroki, Nakayama Izuma, Ogura Mariko, Ooki Akira, Shinozaki Eiji, Chin Keisho, Yamaguchi Kensei
Department of Gastrointestinal Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake Koto-ku, Tokyo, 135-8550, Japan.
Int J Clin Oncol. 2023 Jan;28(1):121-129. doi: 10.1007/s10147-022-02263-0. Epub 2022 Nov 21.
Alpha-Fetoprotein Producing Gastric Cancer (AFPGC) is an aggressive subgroup of gastric cancer. Recently ramucirumab has shown survival benefits in hepatocellular carcinoma, but only in those with higher Alpha-Fetoprotein (AFP) levels. However, the efficacy of ramucirumab-containing chemotherapy in AFPGC remains unclear.
We retrospectively assessed 352 patients who received ramucirumab-containing chemotherapy between June 2015 and December 2019. AFPGC was defined when serum AFP levels were elevated at diagnosis and correlated with the disease state during treatment. Non-AFPGC was defined when serum AFP levels were normal at diagnosis.
Among the 352 patients, 28 patients were defined as AFPGC and 246 patients were defined as non-AFPGC. AFPGC was characterized by high frequency of liver metastasis and low frequency of peritoneal metastasis compared to non-AFPGC. Ramucirumab containing chemotherapy showed higher response rates in AFPGC (39.1% vs 24.8%, p = 0.198) and disease control rates (86.9% vs 61.5%, p = 0.028) than those of non-AFPGC, respectively. Median progression-free survival (PFS) was 5.5 months (95%CI 3.9-7.1) in AFPGC and 4.0 months (95%CI 3.6-4.6) in non-AFPGC (HR: 0.91, 95% CI 0.61-1.36, p = 0.66), and median overall survival (OS) was 10.7 months (95% CI 7.4-20.8) in AFPGC and 9.2 months (95% CI 8.1-10.4) in non-AFPGC (HR: 0.72, 95% CI 0.48-1.08, p = 0.11), respectively. In multivariate analysis, AFPGC was not a negative prognostic factor both for PFS and OS.
Ramucirumab containing chemotherapy showed higher response and comparable survival in AFPGC compared to those of non-AFPGC. Considering the generally poor prognosis of AFPGC, ramucirumab-containing chemotherapy might be a promising treatment option in AFPGC.
甲胎蛋白产生型胃癌（AFPGC）是胃癌的一个侵袭性亚组。最近，雷莫西尤单抗已显示出对肝细胞癌有生存获益，但仅在甲胎蛋白（AFP）水平较高的患者中。然而，含雷莫西尤单抗的化疗在AFPGC中的疗效仍不清楚。
我们回顾性评估了2015年6月至2019年12月期间接受含雷莫西尤单抗化疗的352例患者。当诊断时血清AFP水平升高且与治疗期间疾病状态相关时定义为AFPGC。当诊断时血清AFP水平正常时定义为非AFPGC。
在352例患者中，28例被定义为AFPGC，246例被定义为非AFPGC。与非AFPGC相比，AFPGC的特征是肝转移频率高和腹膜转移频率低。含雷莫西尤单抗的化疗在AFPGC中的缓解率（39.1%对24.8%，p = 0.198）和疾病控制率（86.9%对61.5%，p = 0.028）分别高于非AFPGC。AFPGC的中位无进展生存期（PFS）为5.5个月（95%CI 3.9 - 7.1），非AFPGC为4.0个月（95%CI 3.6 - 4.6）（HR：0.91，95%CI 0.61 - 1.36，p = 0.66），AFPGC的中位总生存期（OS）为10.7个月（95%CI 7.4 - 20.8），非AFPGC为9.2个月（95%CI 8.1 - 10.4）（HR：0.72，95%CI 0.48 - 1.08，p = 0.11）。在多变量分析中，AFPGC对PFS和OS均不是不良预后因素。
与非AFPGC相比，含雷莫西尤单抗的化疗在AFPGC中显示出更高的缓解率和相当的生存率。考虑到AFPGC总体预后较差，含雷莫西尤单抗的化疗可能是AFPGC中一种有前景的治疗选择。
