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Salvage therapy improves survival in pretreated gastric cancer

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – When patients with advanced gastric cancer have not benefitted from one or two chemotherapy regimens for metastatic disease, salvage chemotherapy improves their overall survival — by a median of 1.5 months.

That finding comes from a Korean trial, reported in the Journal of Clinical Oncology online March 12. “Chemotherapy regimens involved were well tolerated, and there were no deaths resulting from toxicity,” the authors note.

Dr. Se Hoon Park, with Sungkyunkwan University Samsung Medical Center, Seoul, and colleagues explain that salvage chemotherapy is often offered to patients with advanced gastric cancer. However, its benefits are unclear and toxicity could actually worsen outcomes.

To investigate, the team conducted a randomized open-label trial in which patients with pretreated advanced gastric cancer were assigned to salvage therapy with irinotecan or docetaxel, plus best supportive care (n=133), or to best supportive care alone (n=69).

Median overall survival was 5.3 months in the salvage chemo arm compared with 3.8 months with best supportive care alone, the authors report. This translated to mortality hazard ratio of 0.657 (p=0.007). The survival benefit was consistent regardless of age, prior best response to chemo, hemoglobin levels, and several other baseline characteristics.

The most common salvage chemotherapy toxicity was myelosuppression, which was transient and easily managed in most cases, the report indicates. Overall, treatment was well tolerated, the team reports, but they note that data on quality of life issues were not collected.

“Despite recent advances, prognosis of patients with AGC (advanced gastric cancer) remains poor,” Dr. Park and colleagues comment. They conclude, based on their findings and results of other trials, that salvage chemotherapy “should be considered a standard of care in patients with AGC.”

They add, “It is conceivable that the addition of a second drug, notably molecularly targeted agents, to docetaxel or irinotecan could improve efficacy in treating patients with pretreated AGC without compromising tolerability.”

SOURCE:
Salvage Chemotherapy for Pretreated Gastric Cancer: A Randomized Phase III Trial Comparing Chemotherapy Plus Best Supportive Care With Best Supportive Care Alone

J Clin Oncol 2012;30.