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. 2023 Sep;26(5):763-774.
doi: 10.1007/s10120-023-01404-2. Epub 2023 Jun 7.

Neoadjuvant chemotherapy in older patients with gastric cancer undergoing surgery: a population-based cohort study

Kammy Keywani #  1   2 , Alexander B J Borgstein #  1   2 , Wietse J Eshuis  1   2 , Marieke Pape  2   3   4 , Kathelijn S Versteeg  2   5 , Sarah Derks  2   5   6 , Hanneke W M van Laarhoven  2   4 , Suzanne S Gisbertz  1   2 , Rob H A Verhoeven  2   3   4 , Mark I van Berge Henegouwen  7   8
Affiliations

Neoadjuvant chemotherapy in older patients with gastric cancer undergoing surgery: a population-based cohort study

Kammy Keywani et al. Gastric Cancer. 2023 Sep.

Abstract

Background: In trials evaluating perioperative chemotherapy for gastric cancer, which serve as the basis for treatment guidelines, patients are selected. The generalizability of these trial findings to older patients is uncertain.

Methods: This population-based retrospective cohort study compared the survival outcomes of patients ≥ 75 years with gastric adenocarcinoma treated with or without neoadjuvant chemotherapy between 2015 and 2019. Additionally, the percentage of patients < 75 years and ≥ 75 years who did not proceeded to surgery after receiving neoadjuvant chemotherapy were examined.

Results: A total of 1995 patients, of whom 1249 aged < 75 years and 746 aged ≥ 75 years, were included. In the group of patients ≥ 75 years, 275 patients received neoadjuvant chemotherapy and 471 patients were directly scheduled for gastrectomy. Patients ≥ 75 years treated with or without neoadjuvant chemotherapy differed significantly from one and another in characteristics. Overall survival of patients ≥ 75 years treated with or without neoadjuvant chemotherapy was not significantly different (median 34.9 vs. 32.3 months; P = 0.506), also after adjusting for potential confounders (HR 0.87; P = 0.263). Of patients ≥ 75 years who received neoadjuvant chemotherapy, 43 (15.6%) did not proceed to surgery compared to 111 (8.9%) patients < 75 years (P < 0.001).

Conclusion: Patients ≥ 75 years treated with or without chemotherapy were highly selected, and overall survival was not significantly different between both groups. Nonetheless, the proportion of patients who did not proceed to surgery following neoadjuvant chemotherapy was higher in patients ≥ 75 years compared to patients < 75 years. Therefore, neoadjuvant chemotherapy should be considered with more caution in patients ≥ 75 years, while identifying those who may benefit.

Keywords: Gastric cancer; Neoadjuvant chemotherapy; Older patients; Survival.

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Conflict of interest statement

Prof. Dr. van Laarhoven reported being honorary chair upper GI faculty of European Society for Medical Oncology; serving in a consulting or advisory role for Amphera, Astellas, AstraZeneca, Beigene, BMS, Daiichy-Sankyo, Dragonfly, MSD, Novartis, and Servier; receiving research grants and nonfinancial support from Bayer, BMS, Celgene, Janssen, Incyte, Philips, Roche, and Servier; serving as speaker for Astellas, Benecke, Daiichy-Sankyo, JAAP, Medtalks, Novartis, and Travel Congress Management B.V. outside the submitted work. Dr. Verhoeven reported serving in a consulting or advisory role for Daiichi Sankyo; receiving research grant from Bristol Myers Squibb outside the submitted work. Prof. Dr. van Berge Henegouwen reported serving in a consulting or advisory role for Alesi Surgical, BBraun, Johnson and Johnson, Medtronic, and Viatris; receiving research grants from Stryker outside the submitted work. The remaining authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1
Flowchart of 2739 patients with potentially curable gastric adenocarcinoma
Fig. 2
Fig. 2
A Overall survival of patients ≥ 75 years treated with or without neoadjuvant chemotherapy. B Overall survival of patients ≥ 75 years by neoadjuvant treatment regimen
See this image and copyright information in PMC

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