Abstract
Background: Platinum + fluoropyrimidine is a standard front-line therapy for unresectable gastroesophageal adenocarcinoma (GA). Subsequent therapy recommendations are ramucirumab + paclitaxel (RAM/PAC), taxane, irinotecan, or trifluridine-tipiracil. RAM/PAC is the preferred second-line choice; however, patients can have a contraindication due to cumulative neuropathy. Our study assessed varied sequencing of second-line and third-line therapies comparing RAM/PAC followed by fluoropyrimidine + irinotecan (FOLFIRI/CAPEIRI) versus the opposite sequence. Methods: We retrospectively analyzed metastatic GA patients who received at least 3 lines of therapy. Two cohorts were studied. Group A: RAM/PAC second-line with FOLFIRI/CAPEIRI third-line or group B: FOLFIRI/CAPEIRI second-line followed by RAM/PAC. Primary outcome was overall survival (OS). Results: Ninety-four patients were available for analysis (51 pts group A: 43 pts group B). No difference was observed in median OS from the start of second-line therapy (group A = 10.5 months vs. group B = 11.1 months, p = 0.97) or median OS from metastatic disease diagnosis (group A = 19.8 months vs. group B = 19.4 months, p = 0.73). Conclusions: Our study, examining a practical issue of how to sequence second-and third-line therapies, documents that one sequence versus the other does not compromise patient outcomes and overall, our patients had an outstanding OS of beyond 19 months when they receive third-line therapy.
Original language | English (US) |
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Pages (from-to) | 182-187 |
Number of pages | 6 |
Journal | Oncology (Switzerland) |
Volume | 100 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2022 |
Keywords
- Advanced gastric adenocarcinoma
- Esophageal neoplasms
- Irinotecan
- Paclitaxel
- Ramucirumab
ASJC Scopus subject areas
- Oncology
- Cancer Research
MD Anderson CCSG core facilities
- Biostatistics Resource Group