Irinotecan combined with 5-fluorouracil and leucovorin third-line chemotherapy after failure of fluoropyrimidine, platinum, and taxane in gastric cancer: treatment outcomes and a prognostic model to predict survival

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2013-10, Vol.16 (4), p.581-589
• Main Authors: Kang, Eun Joo, Im, Seock-Ah, Oh, Do-Youn, Han, Sae-Won, Kim, Jin-Soo, Choi, In Sil, Kim, Jin Won, Kim, Yu Jung, Kim, Jee Hyun, Kim, Tae-You, Lee, Jong Seok, Bang, Yung-Jue, Lee, Keun-Wook
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Adenocarcinoma - drug therapy; Adenocarcinoma - mortality; Adenocarcinoma - pathology; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Bridged-Ring Compounds - administration & dosage; Camptothecin - administration & dosage; Camptothecin - analogs & derivatives; Cancer Research; Carcinoma, Signet Ring Cell - drug therapy; Carcinoma, Signet Ring Cell - mortality; Carcinoma, Signet Ring Cell - pathology; Female; Fluorouracil - administration & dosage; Follow-Up Studies; Gastric cancer; Gastroenterology; Humans; Leucovorin - administration & dosage; Male; Medicine; Medicine & Public Health; Middle Aged; Neoplasm Metastasis; Neoplasm Recurrence, Local - drug therapy; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Oncology; Original Article; Platinum - administration & dosage; Retrospective Studies; Salvage Therapy; Stomach Neoplasms - drug therapy; Stomach Neoplasms - mortality; Stomach Neoplasms - pathology; Surgical Oncology; Survival Rate; Taxoids - administration & dosage; Treatment Outcome
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-012-0227-5

Background The aim of this study was to evaluate the activity and safety of the combination chemotherapy of 5-fluorouracil (5-FU), leucovorin, and irinotecan (FOLFIRI regimen) after failure of fluoropyrimidine, platinum, and taxane in gastric cancer (GC) and to evaluate the prognostic factors for survival. Methods Patients received biweekly FOLFIRI chemotherapy as third-line treatment. The FOLFIRI-1 consisted of irinotecan (180 mg/m 2 in a 2-h infusion) on day 1, and then leucovorin (200 mg/m 2 in a 2-h infusion) and 5-FU (a 400 mg/m 2 bolus, followed by 600 mg/m 2 in a 22-h continuous infusion) on days 1 and 2. FOLFIRI-2 consisted of irinotecan (180 mg/m 2 in a 2-h infusion) on day 1, and then leucovorin (400 mg/m 2 in a 2-h infusion) and 5-FU (a 400 mg/m 2 bolus, followed by 2400 mg/m 2 in a 46-h continuous infusion) on day 1. Results A total of 158 patients were included. The overall response rate was 9.6 % in patients with measurable lesions. The median progression-free survival (PFS) and overall survival (OS) were 2.1 months [95 % confidence interval (CI), 1.7–2.5] and 5.6 months (95 % CI, 4.7–6.5), respectively. The major grade 3/4 toxicity was myelosuppression (36.7 %). Good performance status (PS), fewer metastatic sites, and longer duration from the first-line to third-line chemotherapy were independent prognostic factors affecting both PFS and OS. Conclusions The FOLFIRI regimen showed antitumor activity and tolerable toxicity profiles against advanced GC in the third-line setting. Patients with good PS, fewer metastatic sites and longer previous treatment duration might have the maximal benefit from third-line chemotherapy.