Cancer Medicine (Jan 2022)

Prognostic factors to predict the survival in patients with advanced gastric cancer who receive later‐line nivolumab monotherapy—The Asahikawa Gastric Cancer Cohort Study (AGCC)

  • Kazuyuki Tanaka,
  • Hiroki Tanabe,
  • Hiroki Sato,
  • Chisato Ishikawa,
  • Mitsuru Goto,
  • Naoyuki Yanagida,
  • Hiromitsu Akabane,
  • Shiro Yokohama,
  • Kimiharu Hasegawa,
  • Yohei Kitano,
  • Yuya Sugiyama,
  • Kyoko Uehara,
  • Yu Kobayashi,
  • Yuki Murakami,
  • Takehito Kunogi,
  • Takahiro Sasaki,
  • Keitaro Takahashi,
  • Katsuyoshi Ando,
  • Nobuhiro Ueno,
  • Shin Kashima,
  • Kentaro Moriichi,
  • Keisuke Sato,
  • Sayaka Yuzawa,
  • Mishie Tanino,
  • Masaki Taruiishi,
  • Yasuo Sumi,
  • Yusuke Mizukami,
  • Mikihiro Fujiya,
  • Toshikatsu Okumura

DOI
https://doi.org/10.1002/cam4.4461
Journal volume & issue
Vol. 11, no. 2
pp. 406 – 416

Abstract

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Abstract Background Chemotherapy for advanced gastric cancer is recommended in the guidelines; however, later‐line treatment remains controversial. Since immune checkpoint inhibitors have been used for the treatment of various malignancies, trials have been performed for gastric cancer. A phase 3 trial indicated the survival benefit of nivolumab monotherapy for gastric cancer patients treated with prior chemotherapy regimens. Patients and methods A regional cohort study was undertaken to determine the real‐world data of nivolumab treatment for patients with advanced or recurrent gastric cancer. The patients were enrolled for 2 years from October 2017 to October 2019 and were prospectively followed for 1 year to examine the overall survival (OS). The patient characteristics were analyzed in a multivariate analysis and a nomogram to predict the probability of survival was generated. Results In total, 70 patients who received nivolumab as ≥third‐line chemotherapy were included in the Asahikawa Gastric Cancer Cohort. The median OS was 7.5 (95% CI, 4.8–10.2) months and the response rate was 18.6%. Diffuse type classification, bone metastasis, high neutrophil/lymphocyte ratio, and high CRP were associated with poor OS/prognosis in the multivariate analysis. A nomogram was developed based on these clinical parameters and the concordance index was 0.80 (95% CI, 0.68–0.91). The responders were aged and were frequently diagnosed with intestinal type gastric cancer, including patients with a HER2‐positive status (27.3%) or microsatellite instability‐high (27.3%) status. Conclusions The regional cohort study of nivolumab monotherapy for gastric cancer patients revealed prognostic factors and a nomogram was developed that could predict the probability of survival.

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