PLoS ONE (Jan 2020)

Second-line treatment in advanced gastric cancer: Data from the Spanish AGAMENON registry.

  • Almudena Cotes Sanchís,
  • Javier Gallego,
  • Raquel Hernandez,
  • Virginia Arrazubi,
  • Ana Custodio,
  • Juana María Cano,
  • Gema Aguado,
  • Ismael Macias,
  • Carlos Lopez,
  • Flora López,
  • Laura Visa,
  • Marcelo Garrido,
  • Nieves Martínez Lago,
  • Ana Fernández Montes,
  • María Luisa Limón,
  • Aitor Azkárate,
  • Paola Pimentel,
  • Pablo Reguera,
  • Avinash Ramchandani,
  • Juan Diego Cacho,
  • Alfonso Martín Carnicero,
  • Mónica Granja,
  • Marta Martín Richard,
  • Carolina Hernández Pérez,
  • Alicia Hurtado,
  • Olbia Serra,
  • Elvira Buxo,
  • Rosario Vidal Tocino,
  • Paula Jimenez-Fonseca,
  • Alberto Carmona-Bayonas

DOI
https://doi.org/10.1371/journal.pone.0235848
Journal volume & issue
Vol. 15, no. 7
p. e0235848

Abstract

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BackgroundSecond-line treatments boost overall survival in advanced gastric cancer (AGC). However, there is a paucity of information as to patterns of use and the results achieved in actual clinical practice.Materials and methodsThe study population comprised patients with AGC in the AGAMENON registry who had received second-line. The objective was to describe the pattern of second-line therapies administered, progression-free survival following second-line (PFS-2), and post-progression survival since first-line (PPS).Results2311 cases with 2066 progression events since first-line (89.3%) were recorded; 245 (10.6%) patients died during first-line treatment and 1326/2066 (64.1%) received a second-line. Median PFS-2 and PPS were 3.1 (95% CI, 2.9-3.3) and 5.8 months (5.5-6.3), respectively. The most widely used strategies were monoCT (56.9%), polyCT (15.0%), ramucirumab+CT (12.6%), platinum-reintroduction (8.3%), trastuzumab+CT (6.1%), and ramucirumab (1.1%). PFS-2/PPS medians gradually increased in monoCT, 2.6/5.1 months; polyCT 3.4/6.3 months; ramucirumab+CT, 4.1/6.5 months; platinum-reintroduction, 4.2/6.7 months, and for the HER2+ subgroup in particular, trastuzumab+CT, 5.2/11.7 months. Correlation between PFS since first-line and OS was moderate in the series as a whole (Kendall's τ = 0.613), lower in those subjects who received second-line (Kendall's τ = 0.539), especially with ramucirumab+CT (Kendall's τ = 0.413).ConclusionThis analysis reveals the diversity in second-line treatment for AGC, highlighting the effectiveness of paclitaxel-ramucirumab and, for a selected subgroup of patients, platinum reintroduction; both strategies endorsed by recent clinical guidelines.