TY - JOUR
T1 - Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study.
AU - Fanotto, Valentina
AU - Fornaro, Lorenzo
AU - Bordonaro, Roberto
AU - Rosati, Gerardo
AU - Rimassa, Lorenza
AU - Di Donato, Samantha
AU - Santini, Daniele
AU - Tomasello, Gianluca
AU - Leone, Francesco
AU - Silvestris, Nicola
AU - Stragliotto, Silvia
AU - Scartozzi, Mario
AU - Giampieri, Riccardo
AU - Nichetti, Federico
AU - Antonuzzo, Lorenzo
AU - Cinieri, Saverio
AU - Avallone, Antonio
AU - Pellegrino, Antonio
AU - Melisi, Davide
AU - Vasile, Enrico
AU - Gerratana, Lorenzo
AU - Aprile, Giuseppe
PY - 2019/7/1
Y1 - 2019/7/1
N2 - 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. 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. 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. 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.
AB - 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. 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. 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. 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.
KW - Advanced gastric cancer
KW - Older patients
KW - Second-line chemotherapy
KW - Survival
U2 - 10.1016/j.jgo.2018.11.009
DO - 10.1016/j.jgo.2018.11.009
M3 - Article
VL - 10
SP - 591
EP - 597
JO - Journal of Geriatric Oncology
JF - Journal of Geriatric Oncology
SN - 1879-4068
ER -