Second-line treatment in advanced gastric cancer: Data from the Spanish AGAMENON registry

• Published in: PLoS ONE 2020, Vol.15 (7), p.e0235848
• Main Authors: Cotes Sanchís, Almudena, Gallego, Javier, Hernandez, Raquel, Arrazubi, Virginia, Custodio, Ana, Cano, Juana María, Aguado, Gema, Macias, Ismael, Lopez, Carlos, López, Flora, Visa, Laura, Garrido, Marcelo, Martínez Lago, Nieves, Fernández Montes, Ana, Limón, María Luisa, Azkárate, Aitor, Pimentel, Paola, Reguera, Pablo, Ramchandani, Avinash, Cacho, Juan Diego, Martín Carnicero, Alfonso, Granja, Mónica, Martín Richard, Marta, Hernández Pérez, Carolina, Hurtado, Alicia, Serra, Olbia, Buxo, Elvira, Vidal Tocino, Rosario, Jimenez-Fonseca, Paula, Carmona-Bayonas, Alberto, Buyukhatipoglu, Hakan
• Format: Report
• Language: English
• Subjects: Cancer research; Care and treatment; Chemotherapy; Comparative analysis; Development and progression; Stomach cancer
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0235848

Background Second-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice. Materials and methods The study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS). Results 2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9-3.3) and 5.8 months (5.5-6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall's [tau] = 0.613), lower in those subjects who received second-line (Kendall's [tau] = 0.539), especially with ramucirumab+CT (Kendall's [tau] = 0.413). Conclusion This analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.