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01-12-2021 | Gastrectomy | Gastrointestinal Oncology

Treatment Switch in Poor Responders with Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Authors: Zining Liu, MD, Yinkui Wang, MD, Fei Shan, MD, Xiangji Ying, MPH, Yan Zhang, MPH, Shuangxi Li, MD, Yongning Jia, MD, Rulin Miao, MD, Kan Xue, MD, Zhemin Li, MD, Ziyu Li, MD, PhD, Jiafu Ji, MD, PhD

Published in: Annals of Surgical Oncology | Issue 13/2021

Abstract

Background

Among locally advanced gastric cancer (LAGC) patients, poor response to initial neoadjuvant chemotherapy (NAC) is associated with unfavorable outcomes; however, changing the postoperative therapy regimen in this group of patients is unclear. We compared the poor responders who continued the original protocols with that of patients who switched treatment after NAC plus D2 gastrectomy.

Methods

Our study included LAGC patients who achieved tumor regression grade 3 according to the American Joint Committee on Cancer/College of American Pathologists system, after NAC, between December 2006 and December 2017 at our institution. Outcomes were overall survival (OS), progression-free survival (PFS), and adverse events during postoperative treatment. The propensity score matching method was used to match patients.

Results

Overall, 160 patients were enrolled in the final analysis set, including 21 switched cases and 139 non-switched cases. A 1:2 matched cohort (21 switching vs. 42 non-switching) was generated to eliminate all confounding factors. No statistical differences were observed in OS and PFS, either in the whole patients (OS: log-rank p = 0.804; PFS: log-rank p = 0.943) or in the matched cohort (OS: log-rank p = 0.907; PFS: log-rank p = 0.670) between the two groups. Patients with changed regimens had a significantly higher rate of peripheral neurotoxicity (p = 0.045). Contrarily, a lower rate of overall adverse events was observed in the non-switching group with marginal significance (p = 0.069).

Conclusion

Adjusting to a non-cross-resistant regimen only by post-NAC pathological evaluation may not be sufficient for designing an effective treatment route for LAGC poor responders. Treatment change required a more scrutinized clinical track, which involved a multifaceted assessment.

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Title: Treatment Switch in Poor Responders with Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy
Authors: Zining Liu, MD
Yinkui Wang, MD
Fei Shan, MD
Xiangji Ying, MPH
Yan Zhang, MPH
Shuangxi Li, MD
Yongning Jia, MD
Rulin Miao, MD
Kan Xue, MD
Zhemin Li, MD
Ziyu Li, MD, PhD
Jiafu Ji, MD, PhD
Publication date: 01-12-2021
Publisher: Springer International Publishing
Keywords: Gastrectomy
Gastric Cancer
Gastric Cancer
Gastrectomy
Cytostatic Therapy
Published in: Annals of Surgical Oncology / Issue 13/2021
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-021-10087-x

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Treatment Switch in Poor Responders with Locally Advanced Gastric Cancer After Neoadjuvant Chemotherapy

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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