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Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry

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Abstract

Background

The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression.

Method

The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted.

Results

415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69–1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%).

Conclusion

The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.

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Acknowledgements

Priscilla Chase Duran for editing the manuscript. Natalia Cateriano, Miguel Vaquero, and IRICOM S.A. for supporting the registry website. Carlos Gómez Martin. Hospital Universitario Doce de Octubre, Madrid. Federico Longo Muñoz. Hospital Universitario Ramon y Cajal, Madrid. Pilar García Alfonso. Hospital Universitario Gregorio Marañon, Madrid. Javier Sastre Varela. Hospital Universitario Clínico San Carlos, Madrid. Juan Carlos Cámara. Hospital Universitario Fundación Alcorcón, Madrid. Marisa Alsina Maqueda. Hospital Universitario Val d'Hebron, Barcelona. Marta Martín Richard. Hospital Universitario Santa Creu i Sant Pau, Barcelona. Carles Pericay Pijaume. Hospital Universitario Parc Tauli, Sabadell. Mª Angeles Vicente. Hospital Morales Meseguer de Murcia, Murcia. Miguel Marin Vera. Hospital Virgen de la Arrixaca, Murcia. Paola Pimentel Cáceres. Hospital Universitario Santa Lucia, Cartagena. Teresa García García. Hospital Universitario Santa Lucia, Cartagena. Raquel Hernández San Gil. Hospital Universitario de Canarias, Tenerife. Carolina Hernández. Hospital Universitario Nuestra Señora de Candelaria, Tenerife. Ana Fernandez Montes. Complexo Hospitalario Universitario de Ourense, Orense. Nieves Martínez Lago. Complejo Hospitalario Universitario de A Coruña, Coruña. Carlos López. Hospital Universitario Marqués de Valdecilla, Santander. Josefa Ferreiro Quintana. Hospital Galdakao‐Usansolo, Galdakao‐Usansolo. Roberto Pazo Cid. Hospital Universitario Miguel Servet, Zaragoza. Aitziber Gil‐Negrete Laborda. Hospital Universitario Donostia, San Sebastián.

Author information

Author notes

  1. A. Viúdez and A. Carmona-Bayonas equally contributed to this work.

Authors and Affiliations

  1. Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain

    A. Viúdez

  2. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain

    A. Carmona-Bayonas

  3. Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain

    J. Gallego & E. Asensio

  4. Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain

    A. Lacalle

  5. Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain

    R. Hernández

  6. Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain

    J. M. Cano

  7. Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain

    I. Macías

  8. Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain

    A. Custodio

  9. Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain

    E. Martínez de Castro

  10. Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain

    A. Sánchez

  11. Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain

    L. Iglesia

  12. Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain

    P. Reguera

  13. Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain

    L. Visa

  14. Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain

    A. Azkarate

  15. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain

    M. Sánchez-Cánovas

  16. Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain

    M. Mangas

  17. Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain

    M. L. Limón

  18. Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    A. Martínez-Torrón

  19. Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain

    A. Ramchandani

  20. Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain

    A. Martín-Carnicero

  21. Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain

    A. Hurtado

  22. Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain

    P. Cerdà

  23. Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile

    M. Garrido

  24. Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain

    R. Sánchez-Bayonas

  25. Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain

    R. Serrano

  26. Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain

    P. Jiménez-Fonseca

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  1. A. Viúdez
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  2. A. Carmona-Bayonas
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  3. J. Gallego
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Consortia

the AGAMENON Study Group

  • Carlos Gómez Martin
  • , Federico Longo Muñoz
  • , Pilar García Alfonso
  • , Javier Sastre Varela
  • , Juan Carlos Cámara
  • , Marisa Alsina Maqueda
  • , Marta Martín Richard
  • , Carles Pericay Pijaume
  • , Mª Angeles Vicente
  • , Miguel Marin Vera
  • , Paola Pimentel Cáceres
  • , Teresa García García
  • , Raquel Hernández San Gil
  • , Carolina Hernández
  • , Ana Fernandez Montes
  • , Nieves Martínez Lago
  • , Carlos López
  • , Josefa Ferreiro Quintana
  • , Roberto Pazo Cid
  •  & Aitziber Gil‐Negrete Laborda

Corresponding author

Correspondence to A. Viúdez.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and subsequent versions.

Informed consent

Informed consent or a substitute for it was obtained from all patients before they were included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Members of “the AGAMENON Study Group” are listed in acknowledgement section.

Appendix

Appendix

See Tables 3, 4 and 5. See Figs. 4, 5, 6, 7, 8 and 9.

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Viúdez, A., Carmona-Bayonas, A., Gallego, J. et al. Optimal duration of first-line chemotherapy for advanced gastric cancer: data from the AGAMENON registry. Clin Transl Oncol 22, 734–750 (2020). https://doi.org/10.1007/s12094-019-02183-y

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