Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2023 Sep 15:14:1264929.
doi: 10.3389/fimmu.2023.1264929. eCollection 2023.

Revalidation of the ATTRACTION-4 study in a real-world setting: a multicenter, retrospective propensity score matching study in China

Yuhong Dai  1 , Yongqing Liu  1 , Zhimin Gong  2 , Lilin He  3 , Lei Wang  2 , Wenjie Yang  3 , Ping Qiu  4 , Fangyuan Zhang  1 , Xianglin Yuan  1 , Henghui Cheng  5 , Hong Qiu  1
Affiliations
Multicenter Study

Revalidation of the ATTRACTION-4 study in a real-world setting: a multicenter, retrospective propensity score matching study in China

Yuhong Dai et al. Front Immunol. .

Abstract

Background: Immune-checkpoint inhibitors (ICIs) combined with chemotherapy have been successfully used in clinical trials to treat advanced gastric cancer. However, the efficacy and safety of first-line immunotherapy combined with chemotherapy in Chinese patients are unknown.

Methods: This multicenter retrospective study included patients with human epidermal growth factor receptor-2 (HER-2) negative advanced gastric cancer treated with first-line chemotherapy or chemotherapy with an ICI between January 2019 and December 2022. Propensity score matching was used to compare progression-free survival (PFS), overall survival, objective response rates, and adverse reactions between cohorts.

Results: After propensity score matching, 138 patients, who had balanced baseline characteristics, were included in the chemotherapy and combination treatment groups. The median follow-up duration was 16.90 months, and the median PFS was 8.53 months (95% confidence interval [CI] 7.77-9.28) in the combination treatment group and 5.97 months (95% CI 4.56-7.37) in the chemotherapy group. The median survival duration was 17.05 months (95% CI 14.18-19.92) in the combination treatment group and 16.46 months (95% CI 12.99-19.93) in the chemotherapy group. The PFS subgroup analysis revealed that age ≥65 years, women, Eastern Cooperative Oncology Group performance status of 1, non-signet ring cell carcinoma, esophagogastric junction, liver metastasis, peritoneal metastasis, no massive ascites, only one metastatic organ, and combined platinum-based chemotherapy correlated with treatment benefit. The incidences of adverse events above grade 3 were comparable between groups.

Conclusions: Our study confirmed the ATTRACTION-4 trial results. Compared with chemotherapy, first-line ICIs combined with chemotherapy prolonged PFS but did not improve overall survival in patients with HER-2-negative advanced gastric cancer.

Keywords: advanced gastric cancer; immune checkpoint inhibitors; overall survival; progression free survival; propensity score matching.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the study.
Figure 2
Figure 2
PFS curves before (A) and after (B) PSM. PFS, progression free survival; PSM, propensity score matching.
Figure 3
Figure 3
OS curves before (A) and after (B) PSM. OS, overall survival; PSM, propensity score matching.
Figure 4
Figure 4
Subgroup analyses of PFS (A) and OS (B) based on baseline characteristics. PFS, progression free survival; OS, overall survival.
Figure 5
Figure 5
OS curve for the treatment with or without ICI. OS, overall survival; ICI, immune checkpoint inhibitors.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, et al. . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin (2021) 71(3):209–49. doi: 10.3322/caac.21660 - DOI - PubMed
    1. Chen W, Zheng R, Baade PD, Zhang S, Zeng H, Bray F, et al. . Cancer statistics in China, 2015. CA Cancer J Clin (2016) 66(2):115–32. doi: 10.3322/caac.21338 - DOI - PubMed
    1. Wang FH, Zhang XT, Li YF, Tang L, Qu XJ, Ying JE, et al. . The Chinese Society of Clinical Oncology (CSCO): Clinical guidelines for the diagnosis and treatment of gastric cancer, 2021. Cancer Commun (Lond) (2021) 41(8):747–95. doi: 10.1002/cac2.12193 - DOI - PMC - PubMed
    1. Kang YK, Chen LT, Ryu MH, Oh DY, Oh SC, Chung HC, et al. . Nivolumab plus chemotherapy versus placebo plus chemotherapy in patients with HER2–negative, untreated, unresectable advanced or recurrent gastric or gastro–oesophageal junction cancer (ATTRACTION–4): a randomised, multicentre, double–blind, placebo–controlled, phase 3 trial. Lancet Oncol (2022) 23(2):234–47. doi: 10.1016/S1470-2045(21)00692-6 - DOI - PubMed
    1. Xu J–M, Jiang H, Pan Y, Gu K, Cang S, Han L, et al. . Abstract CT078: First–line treatment with sintilimab (sin) vs placebo in combination with chemotherapy (chemo) in patients (pts) with unresectable gastric or gastroesophageal junction (G/GEJ) cancer: Final overall survival (OS) results from the randomized, phase III ORIENT–16 trial. Cancer Res (2023) 83:CT078–CT. doi: 10.1158/1538-7445 - DOI

Publication types