Adding salvage chemotherapy to best supportive care was tolerated and improved overall survival among patients with advanced gastric cancer previously treated with both fluoropyrimidines and platinum, administered simultaneously or concurrently. The authors of the study report, published in the Journal of Clinical Oncology, noted that at the time the trial was designed there was no evidence that salvage chemotherapy in patients with advanced gastric cancer substantially prolonged overall survival, but there was a potential for toxicity from the treatment.
A total of 202 patients were enrolled at eight tertiary care centers in Korea, where gastric cancer is the most frequently occurring malignancy. They were randomly assigned in a 2:1 ratio to receive either salvage chemotherapy plus best supportive care or best supportive care alone. “Choice of [salvage chemotherapy]—either docetaxel … 60 mg/m2 every 3 weeks or irinotecan … 150 mg/m2 every 2 weeks—was left to the discretion of investigators,” the authors stated.
Median overall survival was 5.3 months among 133 patients receiving salvage chemotherapy plus best supportive care, compared to 3.8 months among 69 patients receiving only best supportive care (one-sided P = .007). Salvage chemotherapy was generally well tolerated, and adverse events were similar in the two arms. The investigators found no median overall survival difference between docetaxel and irinotecan (5.2 vs 6.5 months; P = .116).
“Despite recent advances, prognosis of patients with [advanced gastric cancer] remains poor,” the researchers noted in their conclusion. “It could be generalized with all the data available, including those from numerous phase II trials, two phase III trials (one among Asian and another among white patients), and different chemotherapy regimens, that [salvage chemotherapy] should be considered a standard of care in patients with [advanced gastric cancer].” The addition of another drug to docetaxel or irinotecan, particularly a molecularly targeted agent, they continued, might improve efficacy in this setting without compromising tolerability. ■
Kang JH, et al: J Clin Oncol. March 15, 2012 (early release online).