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
Affiliations
Sung Hee Lim
Division of Hematology-Oncology, Department of Internal Medicine, Samsung Medical Center
Keun-Wook Lee
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
Jae-Joon Kim
Department of Internal Medicine, School of Medicine, Pusan National University Yangsan Hospital, Pusan National University
Hyeon-Su Im
Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine
In-Ho Kim
Division of Oncology, Department of Internal Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
Hye Sook Han
Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine
Dong-Hoe Koo
Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine
Jang Ho Cho
Division of Oncology, Department of Internal Medicine, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
Chi Hoon Maeng
Division of Hematology-Oncology, Department of Internal Medicine, College of Medicine, Kyung Hee University
Min-Young Lee
Division of Hematology-Oncology, Department of Internal Medicine, Soonchunhyang University Seoul Hospital
Hyo Jin Lee
Division of Hemato-Oncology, Department of Internal Medicine, Chungnam National University Hospital
Jwa Hoon Kim
Department of Internal Medicine, Anam Hospital, Korea University College of Medicine
Sang Gon Park
Department of Hemato-Oncology, Chosun University Hospital
Joo Young Jung
Division of Hemato-Oncology, Hallym University Dongtan Sacred Heart Hospital
Seong-Hoon Shin
Department of Hemato/Oncology, Internal Medicine, Kosin University Gospel Hospital
Ki Hyang Kim
Division of Oncology, Department of Internal Medicine, Inje University College of Medicine, Busan Paik Hospital
Hyeyeong Kim
Department of Hematology and Oncology, Ulsan University Hospital, Ulsan University College of Medicine
So Yeon Oh
Department of Internal Medicine, School of Medicine, Pusan National University Yangsan Hospital, Pusan National University
Minsu Kang
Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine
Minkyu Jung
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System
Sun Young Rha
Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University Health System
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).