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Multicenter Study
. 2022 Sep 16;22(5):818-825.
doi: 10.17305/bjbms.2021.7069.

First-line treatment of patients with HER2-positive metastatic gastric and gastroesophageal junction cancer

Selin Aktürk Esen  1 , Yakup Ergun  2 , Cihan Erol  1 , Rukiye Arikan  3 , Muhammed Muhiddin Er  4 , Muhammed Mustafa Atci  5 , Atakan Topçu  6 , Gökhan Uçar  1 , Baran Akagündüz  7 , Musa Bariş Aykan  8 , Miraç Özen  9 , Naziyet Köse Baytemur  10 , Melike Özçelik  11 , Elif Şahin  12 , Denizcan Güven  13 , Serkan Menekşe  14 , Naziye Ak  15 , Fatih Teker  16 , Engin Kut  14 , Teoman Şakalar  17 , Özkan Alan  18 , Turgut Kaçan  19 , Nazim Serdar Turhal  20 , Saadettin Kiliçkap  13 , Sema Türker  21 , Mehmet Ali Nahit Şendur  1 , Osman Köstek  3 , Mustafa Karaağaç  4 , Abdullah Sakin  5 , Haci Mehmet Türk  6 , Dilek Çağlayan  4 , Şener Cihan  5 , Yusuf Açikgöz  1 , Doğan Uncu  1
Affiliations
Multicenter Study

First-line treatment of patients with HER2-positive metastatic gastric and gastroesophageal junction cancer

Selin Aktürk Esen et al. Bosn J Basic Med Sci. .

Abstract

Fluoropyrimidine+cisplatin/oxaliplatin+trastuzumab therapy is recommended for the first-line treatment of HER2-positive metastatic gastric adenocarcinoma. However, there is no comprehensive study on which platinum-based treatment should be preferred. This study aimed to compare the treatment response and survival characteristics of patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) cancer who received fluorouracil, oxaliplatin, and leucovorin (mFOLFOX)+trastuzumab or cisplatin and fluorouracil (CF)+trastuzumab as first-line therapy. It was a multicenter, retrospective study of the Turkish Oncology Group, which included 243 patients from 21 oncology centers. There were 113 patients in the mFOLFOX+trastuzumab arm and 130 patients in the CF+trastuzumab arm. The median age was 62 years in the mFOLFOX+trastuzumab arm and 61 years in the CF+trastuzumab arm (P = 0.495). 81.4% of patients in the mFOLFOX+trastuzumab arm and 83.1% in the CF+trastuzumab arm had gastric tumor localization (P = 0.735). The median progression-free survival (PFS) was significantly higher in the mFOLFOX+trastuzumab arm (9.4 months vs. 7.3 months, P = 0.024). The median overall survival (OS) was similar in both groups (18.4 months vs. 15.1 months, P = 0.640). Maintenance trastuzumab was continued after chemotherapy in 101 patients. In this subgroup, the median OS was 23.3 months and the median PFS was 13.3 months. In conclusion, mFOLFOX+trastuzumab is similar to CF+trastuzumab in terms of the median OS, but it is more effective in terms of the median PFS in the first-line treatment of HER2-positive metastatic gastric and GEJ cancer. The choice of treatment should be made by considering the prominent toxicity findings of the chemotherapy regimens.

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Conflict of interest statement

Conflicts of interest: Authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Kaplan–Meier analysis for OS of the treatment arms (mFOLFOX+trastuzumab vs. CF+trastuzumab). FOLFOX: Fluorouracil, oxaliplatin, and leucovorin; CF: Cisplatin and fluorouracil; OS: Overall survival.
FIGURE 2
FIGURE 2
Kaplan–Meier analysis for PFS of the treatment arms (mFOLFOX+trastuzumab vs. CF+trastuzumab). FOLFOX: Fluorouracil, oxaliplatin, and leucovorin; CF: Cisplatin and fluorouracil; PFS: Progression-free survival.
FIGURE 3
FIGURE 3
(A) Kaplan–Meier analysis for OS in patients receiving maintenance trastuzumab; (B) Kaplan–Meier analysis for PFS in patients receiving maintenance trastuzumab. OS: Overall survival; PFS: Progression-free survival.
See this image and copyright information in PMC

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