BMC Cancer (Feb 2024)

Real-world outcomes of third-line immune checkpoint inhibitors versus irinotecan-based chemotherapy in patients with advanced gastric cancer: a Korean, multicenter study (KCSG ST22-06)

  • Sung Hee Lim,
  • Keun-Wook Lee,
  • Jae-Joon Kim,
  • Hyeon-Su Im,
  • In-Ho Kim,
  • Hye Sook Han,
  • Dong-Hoe Koo,
  • Jang Ho Cho,
  • Chi Hoon Maeng,
  • Min-Young Lee,
  • Hyo Jin Lee,
  • Jwa Hoon Kim,
  • Sang Gon Park,
  • Joo Young Jung,
  • Seong-Hoon Shin,
  • Ki Hyang Kim,
  • Hyeyeong Kim,
  • So Yeon Oh,
  • Minsu Kang,
  • Minkyu Jung,
  • Sun Young Rha

DOI
https://doi.org/10.1186/s12885-024-11972-w
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 12

Abstract

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Abstract Background Immune checkpoint inhibitor (ICI) or irinotecan-based chemotherapy is frequently used after failure of second-line paclitaxel plus ramucirumab treatment for patients with locally advanced unresectable or metastatic advanced gastric cancer (AGC). This study aimed to compare the efficacy between ICI and irinotecan-based chemotherapy as third-line treatment in patients with AGC. Methods We retrospectively reviewed patients with AGC, whose third-line treatment started between July 2019 and June 2021 at 17 institutions in Korea. The ICI group included patients who received nivolumab or pembrolizumab, and the irinotecan-based chemotherapy group included patients who received irinotecan or FOLFIRI (5-fluorouracil, leucovorin and irinotecan). Results A total of 363 patients [n = 129 (ICI) and n = 234 (irinotecan-based chemotherapy)] were analyzed. The median progression-free survival was 2.3 and 2.9 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.802). The median overall survival (OS) was 5.5 and 6.0 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.786). For all patients included in this study, multivariable analysis showed that weight loss, peritoneal metastasis, low serum sodium or albumin, and short duration of second-line treatment were associated with inferior OS (p < 0.05). ICI showed significantly longer OS than irinotecan-based chemotherapy in patients without peritoneal metastasis. Whereas ICI showed significantly shorter OS in patients without PD-L1 expression than irinotecan-based chemotherapy. Conclusions No significant difference in survival outcome was observed between ICI and irinotecan-based chemotherapy as third-line treatment for AGC patients. ICI might be preferred for patients without peritoneal metastasis and irinotecan-based chemotherapy for patients with tumors without PD-L1 expression. Trial registration This study was registered in the Clinical Trial Registry of Korea ( https://cris.nih.go.kr : KCT 0007732).

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