Individualized Chemotherapy for Metastatic Gastric Cancer: Retrospective Data from a University Hospital in Brazil

Background: Despite the decreased incidence, gastric cancer is still a frequent cause of cancer related death.The 1st line 2 or 3 drugs regimen is still a debatable issue. HER2 targeted therapy has emerged as the standard ofcare, but it is unavailable in the Brazilian Public Health System. The end-point of this trial was overall survival(OS) in patients with metastatic gastric cancer treated in a public university hospital in Brazil. The secondaryend-points were efficacy and safety of regimens with 2 (F+P) or 3 (EOX) drugs to develop an institutionalguideline to facilitate optimal treatments. Materials and
Methods: In this retrospective study, 1st line regimenswere evaluated for OS and PFS stratified by age and ECOG using Cox regression.
Results: 47 patients weretreated over the last 3 years. In 1st line, 29 were treated with F+P (mean 59.3 years, 34.5% ECOG 2 and a meanof 5.69 cycles) and 16 with EOX (mean 47 years, 18.8% ECOG 2 and a mean of 5.44 cycles). The median OSwas 13.8 months (95%CI 10.7-16.9). Response was evaluated in 40 cases and was 64.3% for EOX and 37.5% forF+P (p=0.25). The median PFS was 9.5 months for EOX and 5.6 months for F+P (HR 0.85, 95%CI 0.41-1.74).However, among patients with ECOG 2 mPFS was 3.70 vs 5.40 months, respectively (p=0.86). Regimens showedsimilar manageable adverse events. A total of 34 patients suffered progression and 14 received 2nd line therapy.Diffuse histology (HR 1.89, 95%CI 1.22-2.88), achieving 2nd line (HR: 0.25, 95%CI 0.11-0.58) and treatmentresponse (HR 0.23, 95%CI 0.12-0.47) were OS prognostic factors.
Conclusions: Patients treated in our hospitalhad outcomes compatible with the literature. The regimen choice should be related to patient features. Secondline treatment should be considered.