Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry
Por:
Carmona-Bayonas A, Jiménez-Fonseca P, Custodio A, Sánchez Cánovas M, Hernández R, Pericay C, Echavarria I, Lacalle A, Visa L, Rodríguez Palomo A, Mangas M, Cano JM, Buxo E, Álvarez-Manceñido F, García T, Lorenzo JE, Ferrer-Cardona M, Viudez A, Azkarate A, Ramchandani A, Arias D, Longo F, López C, Sánchez Bayona R, Limón ML, Díaz-Serrano A, Fernández Montes A, Sala P, Cerdá P, Rivera F and Gallego J
Publicada:
1 ene 2018
Resumen:
Background Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry.
Methods Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression.
Result A total of 1002 patients were included (doublets, n = 653; anthracycline-based triplets, n = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78-1.05), p = 0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7-12.3) vs. 9.9 (95% CI, 9.2-11.4) months, HR 0.91 (CI 95%, 0.76-1.083), and (log-rank test, p = 0.226). Response rates (42.1 vs. 33.1%, p = 0.12) and PFS (HR 0.95, CI 95%, 0.80-1.13, log-rank test, p = 0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3-4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision.
Conclusion Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.
Filiaciones:
Carmona-Bayonas A:
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain.
Jiménez-Fonseca P:
Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Custodio A:
Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
Sánchez Cánovas M:
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
Hernández R:
Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
Pericay C:
Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
Echavarria I:
Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain
Lacalle A:
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
Visa L:
Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain
Rodríguez Palomo A:
Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
Mangas M:
Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain
Cano JM:
Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain
Buxo E:
Medical Oncology Department, Hospital Universitario Clinic, Barcelona, Spain
Álvarez-Manceñido F:
Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain
García T:
Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, IMIB, Avenida Marqués de los Vélez, 30008, Murcia, Spain
Lorenzo JE:
Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain
Ferrer-Cardona M:
Medical Oncology Department, Corporació Sanitària Parc Taulí , Sabadell, Spain
Viudez A:
Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain
Azkarate A:
Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain
Ramchandani A:
Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
Arias D:
Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
Longo F:
Medical Oncology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain
López C:
Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
Sánchez Bayona R:
Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
Limón ML:
Medical Oncology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
Díaz-Serrano A:
Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
Fernández Montes A:
Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain
Sala P:
Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain
Cerdá P:
Medical Oncology Department, Clínica Tecknon de Barcelona, Barcelona, Spain
Rivera F:
Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain
:
Medical Oncology Department, Hospital General Universitario de Elche, Elche, Spain
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