Anthracycline-based triplets do not improve the efficacy of platinum-fluoropyrimidine doublets in first-line treatment of advanced gastric cancer: real-world data from the AGAMEMON National Cancer Registry

• Published in: Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 2018, Vol.21 (1), p.96-105
• Main Authors: Carmona-Bayonas, A., Jiménez-Fonseca, P., Custodio, A., Sánchez Cánovas, M., Hernández, R., Pericay, C., Echavarria, I., Lacalle, A., Visa, L., Rodríguez Palomo, A., Mangas, M., Cano, J. M., Buxo, E., Álvarez-Manceñido, F., García, T., Lorenzo, J. E., Ferrer-Cardona, M., Viudez, A., Azkarate, A., Ramchandani, A., Arias, D., Longo, F., López, C., Sánchez Bayona, R., Limón, M. L., Díaz-Serrano, A., Fernández Montes, A., Sala, P., Cerdá, P., Rivera, F., Gallego, J.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Anthracycline; Cancer Research; Epirubicin; Gastric cancer; Gastroenterology; Medicine; Medicine & Public Health; Monoclonal antibodies; Oncology; Original Article; Platinum; Surgical Oncology; Targeted cancer therapy; Toxicity; Trastuzumab
• ISSN: 1436-3291; 1436-3305
• DOI: 10.1007/s10120-017-0718-5

Background Although anthracycline-based triplets are one of the most widely used schedules to treat advanced gastric cancer (AGC), the benefit of including epirubicin in these therapeutic combinations remains unknown. This study aims to evaluate both the efficacy and tolerance of triplets with epirubicin vs. doublets with platinum-fluoropyrimidine in a national AGC registry. Methods Patients with AGC treated with polychemotherapy without trastuzumab at 28 hospitals in Spain between 2008 and 2016 were included. The effect of anthracycline-based triplets against doublets was evaluated by propensity score matching (PSM) and Cox proportional hazards (PH) regression. Result A total of 1002 patients were included (doublets, n  = 653; anthracycline-based triplets, n  = 349). The multivariable Cox PH regression failed to detect significantly increased OS in favor of triplets with anthracyclines: HR 0.90 (95% CI, 0.78–1.05), p   =  0.20035. After PSM, the sample contained 325 pairs with similar baseline characteristics. This method was also unable to reveal an increase in OS: 10.5 (95% CI, 9.7–12.3) vs. 9.9 (95% CI, 9.2–11.4) months, HR 0.91 (CI 95%, 0.76–1.083), and (log-rank test, p   =  0.226). Response rates (42.1 vs. 33.1%, p   =  0.12) and PFS (HR 0.95, CI 95%, 0.80–1.13, log-rank test, p   =  0.873) were not significantly higher with epirubicin-based regimens. The triplets were associated with greater grade 3–4 hematological toxicity, and increased hospitalization due to toxicity by 68%. The addition of epirubicin is viable, but 23.7% discontinued treatment because of adverse effects or patient decision. Conclusion Anthracyclines added to platinum-fluoropyrimidine doublets did not improve the response rate or survival outcomes in patients with AGC but entailed greater toxicity.