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. 2020 Jul 31;15(7):e0235848.
doi: 10.1371/journal.pone.0235848. eCollection 2020.

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

Almudena Cotes Sanchís  1 , Javier Gallego  2 , Raquel Hernandez  3 , Virginia Arrazubi  4 , Ana Custodio  5 , Juana María Cano  6 , Gema Aguado  7 , Ismael Macias  8 , Carlos Lopez  9 , Flora López  10 , Laura Visa  11 , Marcelo Garrido  12 , Nieves Martínez Lago  13 , Ana Fernández Montes  14 , María Luisa Limón  15 , Aitor Azkárate  16 , Paola Pimentel  17 , Pablo Reguera  18 , Avinash Ramchandani  19 , Juan Diego Cacho  9 , Alfonso Martín Carnicero  20 , Mónica Granja  21 , Marta Martín Richard  22 , Carolina Hernández Pérez  23 , Alicia Hurtado  24 , Olbia Serra  25 , Elvira Buxo  26 , Rosario Vidal Tocino  27 , Paula Jimenez-Fonseca  28 , Alberto Carmona-Bayonas  29
Affiliations

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

Almudena Cotes Sanchís et al. PLoS One. .

Abstract

Background: Second-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 methods: The 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).

Results: 2311 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).

Conclusion: This 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.

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Conflict of interest statement

Dr. Javier Gallego declares advisory role for Amgen, Bayer, BMS, Ipsen, Lilly, Merck, Roche, Servier, and travel grants from Novartis, Amgen. No other authors have competing interests to declare. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Time trends in the use of second-line schedules based on HER2 status.
Abbreviations: polyCT, polychemotherapy; monoCT, monochemotherapy; Ram+CT, ramucirumab+chemotherapy.
Fig 2
Fig 2. Response rates according to HER2 and strategy.
Abbreviations: Pl reint, platinum reintroduction; poly-CT, polychemotherapy; P, paclitaxel; Ram, ramucirumab; CT, chemotherapy; Trastu, trastuzumab; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; NA, not available. *Paclitaxel was the cytotoxic used in all patients with HER-negative tumors who received ramucirumab+chemotherapy, whereas paclitaxel and other cytotoxics were associated with ramucirumab in HER+ tumors.
Fig 3
Fig 3. Survival curves for PFS-2 and PPS (n = 1326).
Abbreviations: PFS-2, progression-free survival to second-line of treatment; PPS, post-progression survival.
Fig 4
Fig 4. Survival functions since initiation of second-line by HER2 status and treatment strategy.
Abbreviations: PFS-2, progression-free survival to second-line of treatment; PPS, post-progression survival; CT, chemotherapy; Pacli, paclitaxel.
See this image and copyright information in PMC

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