Efficacy of a triplet and doublet-based chemotherapy as first-line therapy in patients with HER2-negative metastatic gastric cancer: a retrospective analysis from the clinical practice

• DOI: 10.1007/s12032-017-1046-7
• Publication Date: 2017-10-17T06:16:27Z
• Authors: Maria Maddalena L...; Luca Pompella; Angelica Petrillo; Giuseppe Tirino; Annalisa Pappalardo; Michele Orditura; Teresa Troiani; Fortunato Ciardiello; Natale Di Martino; Ferdinando De Vita
• Keywords: Adult; Male; Organoplatinum Compounds; Receptor, ErbB-2; Leucovorin; Middle Aged; 3. Good health; Oxaliplatin; Chemotherapy; ECX; FOLFOX; Metastatic gastric cancer; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Stomach Neoplasms; Antineoplastic Combined Chemotherapy Protocols; Humans; Female; Fluorouracil; Cisplatin; Capecitabine; Aged; Retrospective Studies

The best choice of chemotherapy regimen for patients with metastatic gastric cancer is still debated. Although several studies support a superior efficacy of a triplet chemotherapy regimen over a doublet-based regimen, the magnitude of this benefit appears small and accompanied by an increased toxicity. Based on this background, we evaluated the outcome of patients with HER2-negative metastatic gastric cancer (mGC) who received in the clinical practice a triplet or doublet regimen as first-line therapy. A total of 165 patients (pts) with HER2-negative mGC treated outside of clinical trials at our department with FOLFOX-4 or ECX from 2012 and 2015 were included in our retrospective analysis: FOLFOX-4: 86 pts; ECX: 79 pts. Median progression-free survival (PFS) was 5.1 months for FOLFOX-4 and 5.6 months for ECX regimen, respectively. Median overall survival (OS) was 10.3 months for FOLFOX-4 and 10.9 months for ECX regimens.grade 3-4 vomiting (12.6%), neutropenia (31.6%), mucositis (11.3%) and fatigue (22.7%) occurred more frequently in ECX regimen, while grade 3-4 peripheral neuropathy was more common with FOLFOX-4 (19.7%). Both evaluated regimens are active and safe in the palliation of HER2-negative mGC in the first-line setting: Three-drug chemotherapy regimen appear more active but offer only a slight improvement in OS with an increased G3-G4 toxicity. Our data suggest that a doublet therapy should be preferred in the clinical practice, preferentially reserving a three-drug combination to pts with bulky disease and/or to pts with initially unresectable locally advanced disease.