Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study

Valentina Fanotto, Lorenzo Fornaro, Roberto Bordonaro, Gerardo Rosati, Lorenza Rimassa, Samantha Di Donato, Daniele Santini, Gianluca Tomasello, Francesco Leone, Nicola Silvestris, Silvia Stragliotto, Mario Scartozzi, Riccardo Giampieri, Federico Nichetti, Lorenzo Antonuzzo, Saverio Cinieri, Antonio Avallone, Antonio Pellegrino, Davide Melisi, Enrico VasileLorenzo Gerratana, Giuseppe Aprile

Research output: Contribution to journalArticle

Abstract

Objectives: Although gastric cancer (GC) incidence rises with age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Materials and Methods: Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. Results: Older patients represented 31.8% of the population (N = 868). Intestinal type was more frequent in older patients (P =.02). Poorly differentiated tumours were more often observed in non-older patients (P =.009). At stage IV diagnosis, the rate of liver metastases was higher in older patients (P =.02), while peritoneal spread was more represented in non-older patients (P =.002). Although older patients were more often treated with monotherapy (P =.001), they had similar PFS (HR 0.86, 95%CI 0.71–1.03, P =.102) and OS (HR 0.82, 95%CI 0.65–1.02, P =.08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. Conclusion: In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.

Original languageEnglish
JournalJournal of Geriatric Oncology
DOIs
Publication statusAccepted/In press - Jan 1 2018

Keywords

  • Advanced gastric cancer
  • Older patients
  • Second-line chemotherapy
  • Survival

ASJC Scopus subject areas

  • Oncology
  • Geriatrics and Gerontology

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    Fanotto, V., Fornaro, L., Bordonaro, R., Rosati, G., Rimassa, L., Di Donato, S., Santini, D., Tomasello, G., Leone, F., Silvestris, N., Stragliotto, S., Scartozzi, M., Giampieri, R., Nichetti, F., Antonuzzo, L., Cinieri, S., Avallone, A., Pellegrino, A., Melisi, D., ... Aprile, G. (Accepted/In press). Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study. Journal of Geriatric Oncology. https://doi.org/10.1016/j.jgo.2018.11.009