Sistema de Salut de Catalunya
Institut Català de la Salut
[Jimenez-Fonseca P] Medical Oncology Department, Hospital Universitario Central de Asturias, ISPA, Oviedo, Spain. [Carmona-Bayonas A] Medical Oncology Department, Hospital Universitario Morales Meseguer, 30007 Murcia, Spain. [Martinez-Torron A] Pharmacy Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. [Alsina M] Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona. Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain. [Custodio A] Medical Oncology Department, Hospital Universitario La Paz, CIBERONC CB16/12/00398, Madrid, Spain. [Serra O] Medical Oncology Department, Catalan Institute of Oncology, L’Hospitalet, Spain
Vall d'Hebron Barcelona Hospital Campus
2022-02-22T11:44:39Z
2022-02-22T11:44:39Z
2021-01
Quimioteràpia; Càncer gàstric; Trastuzumab
Quimioterapia; Cáncer gástrico; Trastuzumab
Chemotherapy; Gastric cancer; Trastuzumab
Background: Trastuzumab combined with cisplatin and fluoropyrimidines, either capecitabine or 5-fluorouracile (XP/FP), is the standard first-line treatment for advanced, HER2-positive, gastric cancer patients based on the ToGA trial. Despite the lack of phase III trials, many clinicians administer trastuzumab with alternative regimens. One meta-analysis suggests that substituting cisplatin for oxaliplatin might lead to greater efficacy and less toxicity. Methods: 594 patients with HER2-positive gastroesophageal adenocarcinoma were recruited from the AGAMENON-SEOM registry. The objective was to evaluate the external validity of clinical trials with chemotherapy and trastuzumab. Results: The regimens used in at least 5% of the patients were XP (27%), oxaliplatin and capecitabine (CAPOX) (26%), oxaliplatin and 5-fluorouracil (FOLFOX) (14%), FP (14%), triplet with anthracycline/docetaxel (7%), and carboplatin-FU (5%). Median exposure to trastuzumab was longer with FOLFOX (11.4 months, 95% CI, 9.1–21.0) versus ToGA regimens (7.5, 6.4–8.5), p < 0.001. Patients with HER2-IHC 3+ cancers had higher response rates than those with IHC 2+/FISH+, odds-ratio 1.97 (95% CI, 1.25–3.09). The results achieved with CAPOX–trastuzumab were comparable to those attained with ToGA regimens. FOLFOX–trastuzumab was superior to ToGA schemes in terms of overall survival (OS), with a greater magnitude of effect in IHC 2+/FISH+ tumors (HR 0.47, 0.24–0.92) compared with IHC 3+ (HR 0.69, 0.49–0.96), and in diffuse (HR 0.37, 0.20–0.69) versus intestinal-type tumors (HR 0.76, 0.54–1.06). Conclusion: We have updated the external validity of clinical trials with trastuzumab in first-line treatment of gastric cancer. Our data confirm the comparable outcomes of ToGA regimens and CAPOX–trastuzumab in clinical practice and point toward a possible benefit of FOLFOX–trastuzumab, contingent on the subtypes typically less sensitive to trastuzumab, to be confirmed in clinical trials.
The authors received no financial support for the research, authorship, and/or publication of this article.
Article
Published version
English
Esòfag - Càncer - Tractament; Estómac - Càncer - Tractament; Quimioteràpia combinada; DISEASES::Neoplasms::Neoplasms by Site::Digestive System Neoplasms::Gastrointestinal Neoplasms::Esophageal Neoplasms; Other subheadings::Other subheadings::Other subheadings::/drug therapy; ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT::Therapeutics::Therapeutics::Drug Therapy::Antineoplastic Protocols::Therapeutics::Drug Therapy::Antineoplastic Combined Chemotherapy Protocols; Other subheadings::Other subheadings::/therapeutic use; ENFERMEDADES::neoplasias::neoplasias por localización::neoplasias del sistema digestivo::neoplasias gastrointestinales::neoplasias del esófago; Otros calificadores::Otros calificadores::Otros calificadores::/farmacoterapia; TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS::terapéutica::terapéutica::farmacoterapia::protocolos antineoplásicos::terapéutica::farmacoterapia::protocolos de quimioterapia antineoplásica combinada; Otros calificadores::Otros calificadores::/uso terapéutico
SAGE Publications
Therapeutic Advances in Medical Oncology;13
https://doi.org/10.1177/17588359211019672
Attribution-NonCommercial 4.0 International
http://creativecommons.org/licenses/by-nc/4.0/
