Second-Line Irinotecan after Cisplatin, Fluoropyrimidin and Docetaxel for Chemotherapy of Metastatic Gastric Cancer


Aim: Tumors of upper gastrointestinal tract are among the cancers that have a quite lethal course. Cytotoxicchemotherapy is the most efficient therapeutic modality for metastatic gastric cancer. In patients who do notrespond to first-line treatment, the response rate to second-line therapies is generally low and the toxicityrates high. This study concerned the efficacy and the side effect profile of second-line therapy with irinotecanin the patients who were being followed-up with the diagnosis of metastatic gastric cancer in İzmir, Turkey.Materials and
Methods: We retrospectively evaluated the efficacy and toxicity in 31 patients with metastaticgastric adenocarcinoma who presented to the polyclinic of Medical Oncology of Izmir Ataturk Education andResearch Hospital between May 2008 and July 2011. All received chemotherapy regimens containing cisplatin,fluoropyrimidine (5-FU) and docetaxel as the first-line therapy for late stage disease. Irinotecan as a singleagent was given at a dose of 210 mg/m2 on each 21 days. Irinotecan (180 mg/m2 on day 1), 5-FU (500 mg/m2 ondays 1-2) and leucovorin (LV; 60 mg/m2 on days 1-2) as a combined regimen were given over a 14 day period.
Results: Median age was 54 (range, 31-70). Irinotecan was given as a combined regimen for median 6 cycles(range, 3-12) and as a single agent for median 3 cycles (range, 1-10). Metastases were detected in one site in sixpatients (19%), in two different sites in 17 patients (55%) and in three or more sites in eight patients (26%).Four patients (12.9%) showed partial response and six patients (19.3%) showed stable disease. Progressionfreesurvival (PFS) was found to be 3.26 months (95% CI, 2.3-4.2). Median overall survival (OS) was found tobe 8.76 months (95% CI, 4.5-12.9). The most commonly seen grade 3/4 side effect was neutropenia but the thetherapy was generally well-tolerated.
Conclusions: In this study, it was demonstrated that second-line therapywith irinotecan given following the first-line therapy with cisplatin, fluoropyrimidine (5-FU) and docetaxel wasefficient and safe. Further studies are needed for confirmation.