Lauren subtypes of advanced gastric cancer influence survival and response to chemotherapy: real-world data from the AGAMENON National Cancer Registry
Por:
Jimenez Fonseca, P, Carmona-Bayonas, A, Hernandez, R, Custodio, A, Maria Cano, J, Lacalle, A, Echavarria, I, Macias, I, Mangas, M, Visa, L, Buxo, E, Alvarez Mancenido, F, Viudez, A, Pericay, C, Azkarate, A, Ramchandani, A, Lopez, C, Martinez de Castro, E, Fernandez Montes, A, Longo, F, Sanchez Bayona, R, Luisa Limon, M, Diaz-Serrano, A, Martin Carnicero, A, Arias, D, Cerda, P, Rivera, F, Maria Vieitez, J, Sanchez Canovas, M, Garrido, M, Gallego, J and AGAMENON Study Grp
Publicada:
5 sep 2017
Resumen:
BACKGROUND: The choice of chemotherapy in HER2-negative gastric cancer is based on centre's preferences and adverse effects profile. No schedule is currently accepted as standard, nor are there any factors to predict response, other than HER2 status. We seek to evaluate whether Lauren type influences the efficacy of various chemotherapies and on patient overall survival (OS).
METHODS: We have conducted a multicenter study in 31 hospitals. The eligibility criteria include diagnosis of stomach or gastroesophageal junction adenocarcinoma, HER2 negativity, and chemotherapy containing 2-3 drugs. Cox proportional hazards regression adjusted for confounding factors, with tests of 'treatment-by-histology' interaction, was used to estimate treatment effect.
RESULTS: Our registry contains 1303 tumours analysable for OS end points and 730 evaluable for overall response rate (ORR). A decrease in ORR was detected in the presence of a diffuse component: odds ratio 0.719 (95% confidence interval (CI), 0.525-0.987), P = 0.039. Anthracycline-or docetaxel-containing schedules increased ORR only in the intestinal type. The diffuse type displayed increased mortality with hazard ratio (HR) of 1.201 (95% CI, 1.054-1.368), P = 0.0056. Patients receiving chemotherapy with docetaxel exhibited increased OS limited to the intestinal type: HR 0.65 (95% CI, 0.49-0.87), P = 0.024, with no increment in OS for the subset having a diffuse component. With respect to progression-free survival (PFS), a significant interaction was seen in the effect of docetaxel-containing schedules, with better PFS limited to the intestinal type subgroup, in the comparison against any other schedule: HR 0.65 (95% CI, 0.50-0.85), P = 0.015, and against anthracycline-based regimens: HR 0.64 (95% CI, 0.46-0.88), P = 0.046.
CONCLUSIONS: As a conclusion, in this registry, Lauren classification tumour subtypes predicted survival and responded differently to chemotherapy. Future clinical trials should stratify effect estimations based on histology.
Filiaciones:
Jimenez Fonseca, P:
Cent Asturias Univ Hosp, Dept Med Oncol, Oviedo 33011, Spain
Carmona-Bayonas, A:
Morales Meseguer Univ Hosp, Dept Hematol & Med Oncol, Murcia 30008, Spain
Hernandez, R:
Canarias Univ Hosp, Dept Med Oncol, Tenerife 38320, Spain
Custodio, A:
La Paz Univ Hosp, Dept Med Oncol, Madrid 28046, Spain
Maria Cano, J:
Ciudad Real Gen Hosp, Dept Med Oncol, Ciudad Real 13005, Spain
Lacalle, A:
Complejo Hosp Navarra, Dept Med Oncol, Pamplona 31008, Spain
Echavarria, I:
Gregorio Maranon Univ Hosp, Dept Med Oncol, Madrid 28007, Spain
Macias, I:
Parc Tauli Univ Hosp, Dept Med Oncol, Sabadell 08208, Spain
Mangas, M:
Hosp Galdakao Usansolo, Dept Med Oncol, Galdakao Usansolo 48960, Spain
Visa, L:
El Mar Univ Hosp, Dept Med Oncol, Barcelona 08003, Spain
Buxo, E:
Hosp Clin Barcelona, Dept Med Oncol, Barcelona 08036, Spain
Alvarez Mancenido, F:
Cent Asturias Univ Hosp, Dept Pharm, Oviedo 30008, Spain
Viudez, A:
Complejo Hosp Navarra, Dept Med Oncol, Pamplona 31008, Spain
Pericay, C:
Parc Tauli Univ Hosp, Dept Med Oncol, Sabadell 08208, Spain
Azkarate, A:
Son Espases Univ Hosp, Dept Med Oncol, Mallorca 07120, Spain
Ramchandani, A:
Insular Gran Canaria Univ Hosp, Dept Med Oncol, Las Palmas Gran Canaria 35016, Spain
Lopez, C:
Marques Valdecilla Univ Hosp, Dept Med Oncol, Santander 39008, Spain
Martinez de Castro, E:
Marques Valdecilla Univ Hosp, Dept Med Oncol, Santander 39008, Spain
Fernandez Montes, A:
Complejo Hosp Orense, Dept Med Oncol, Orense 32005, Spain
Longo, F:
Ramon y Cajal Univ Hosp, Dept Med Oncol, Madrid 28034, Spain
Sanchez Bayona, R:
Clin Univ Navarra, Dept Med Oncol, Pamplona 31008, Spain
Luisa Limon, M:
Virgen Roci Univ Hosp, Dept Med Oncol, Seville 41013, Spain
Diaz-Serrano, A:
12 Octubre Univ Hosp, Dept Med Oncol, Madrid 41013, Spain
Martin Carnicero, A:
Hosp San Millan San Pedro, Dept Med Oncol, Logrono 26006, Spain
Arias, D:
Complejo Hosp Orense, Dept Med Oncol, Orense 32005, Spain
Cerda, P:
Tecknon Canc Inst, Dept Med Oncol, Barcelona 08022, Spain
Rivera, F:
Marques Valdecilla Univ Hosp, Dept Med Oncol, Santander 39008, Spain
Maria Vieitez, J:
Cent Asturias Univ Hosp, Dept Med Oncol, Oviedo 33011, Spain
Sanchez Canovas, M:
Morales Meseguer Univ Hosp, Dept Hematol & Med Oncol, Murcia 30008, Spain
Garrido, M:
Pontificia Univ Catolica Chile, Dept Med Oncol, Santiago, Chile
:
Elche Univ Hosp, Dept Med Oncol, Elche 03203, Spain
Green Published, hybrid
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