Expert Point of View: Johanna C. Bendell, MD

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The study’s formal discussant, Johanna C. Bendell, MD, Director of Gastrointestinal Cancer Research and at the Sarah Cannon Research Institute, Nashville, said COUGAR02 had “good and appropriate stratification factors” and “importantly, included quality-of-life studies.” This is critical, she said, because the goal in treating the advanced gastric cancer population should be “not only to help them live longer but to live better.” 

Only about 20% of such patients receive second-line treatment, she noted, largely because they are too ill.  “The evidence that this is a difficult population to treat is the fact that, even within this clinical trial, only 23% receiving docetaxel and 36% receiving best supportive care completed their intended treatment,” she observed.

Confirms Previous Findings

Consistent with findings from previous second-line studies, COUGAR-02 showed “that chemotherapy with docetaxel does benefit patients in the second line. Docetaxel and irinotecan [from prior trials] both work, but the overall benefit is still just about 1.5 months,” she emphasized.

“Thus, maybe when making treatment decisions, we need to think about who will receive the most benefit,” Dr. Bendell suggested. “Here, it was patients with longer disease-free intervals and those with better performance status. Patients who responded did live longer and did feel better, and we should keep this in mind when thinking about treating this sick population.” ■

Disclosure: Dr. Bendell reported no potential conflicts of interest.

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