Yao Yanhong, Liu Zhentao, Zhang Hua, Shi Xinhua, Huang Fangfang, Zhang Yi, Chen Lu, Shi Yanyan, Cao Baoshan
Department of Medical Oncology and Radiation Sickness, Peking University Third Hospital, Beijing, China.
Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing, China.
Asia Pac J Oncol Nurs. 2025 Jul 7;12:100750. doi: 10.1016/j.apjon.2025.100750. eCollection 2025 Dec.
To evaluate the feasibility of modified systemic anti-cancer therapy in unresectable gastric cancer or gastroesophageal junction cancer (GC/GEJC) patients with overt bleeding (OB).
This retrospective study included individuals with unresectable GC/GEJC and OB who received systemic anti-cancer therapy. Treatment feasibility was assessed. Risk factors for persistent overt bleeding post systemic therapy (POBPST) were explored.
Among the 52 individuals included, 19 (36.5%) experienced active OB within one month prior to initiating anti-cancer therapy, while 33 (63.5%) did not. Hemostasis was achieved via endoscopic intervention in 2 patients and conservative medical management in 17. A total of 5 patients received immune checkpoint inhibitor monotherapy, and 47 received chemotherapy-based systemic therapy, with 70.2% (33/47) requiring a 25% dose reduction. Among those with active OB, 73.7% (14/19) received intravenous therapy, with a median interval of 16 days (range: 3-25) from hemostasis to treatment initiation. The overall objective response rate (ORR) and disease control rate (DCR) were 42.3% and 90.4%, respectively. Median progression-free survival (mPFS) and overall survival (mOS) were 10.3 and 16.1 months. POBPST occurred in 28.8% of individuals and was associated with poorer survival. Grade 3-4 treatment-related adverse events occurred in 36.5% of patients. Multivariate analysis identified a Modified Barthel Index (MBI) score < 75 and disease progression or stable disease as independent risk factors for POBPST.
With appropriate hemostatic management, modified dose systemic anti-cancer therapy was feasible and generally well tolerated in patients with unresectable GC/GEJC and OB. Nurses' role was indispensable for this high-risk population.
The study has been registered in clinical trials.gov (NCT06522542).
评估改良全身抗癌治疗在无法切除的胃癌或胃食管交界癌（GC/GEJC）伴明显出血（OB）患者中的可行性。
这项回顾性研究纳入了接受全身抗癌治疗的无法切除的GC/GEJC和OB患者。评估治疗可行性。探索全身治疗后持续明显出血（POBPST）的危险因素。
纳入的52例患者中，19例（36.5%）在开始抗癌治疗前1个月内出现活动性OB，33例（63.5%）未出现。2例患者通过内镜干预止血，17例通过保守药物治疗止血。共有5例患者接受免疫检查点抑制剂单药治疗，47例接受基于化疗的全身治疗，其中70.2%（33/47）需要降低25%的剂量。在活动性OB患者中，73.7%（14/19）接受静脉治疗，从止血到开始治疗的中位间隔时间为16天（范围：3 - 25天）。总体客观缓解率（ORR）和疾病控制率（DCR）分别为42.3%和90.4%。中位无进展生存期（mPFS）和总生存期（mOS）分别为10.3个月和16.1个月。28.8%的患者发生POBPST，且与较差的生存率相关。3 - 4级治疗相关不良事件发生在36.5%的患者中。多因素分析确定改良巴氏指数（MBI）评分<75以及疾病进展或病情稳定是POBPST的独立危险因素。
通过适当的止血管理，改良剂量的全身抗癌治疗在无法切除的GC/GEJC和OB患者中是可行的，且一般耐受性良好。护士对这一高危人群的作用不可或缺。
该研究已在临床试验.gov注册（NCT06522542）。
