Alberto Carmona-Bayonas1, Paula Jiménez-Fonseca1, Maria Luisa Sánchez Lorenzo1, Avinash Ramchandani1, Elena Asensio Martínez1, Ana Custodio1, Marcelo Garrido1, Isabel Echavarría1, Juana María Cano1, Jose Enrique Lorenzo Barreto1, Teresa García García1, Felipe Álvarez Manceñido1, Alejandra Lacalle1, Marta Ferrer Cardona1, Monserrat Mangas1, Laura Visa1, Elvira Buxó1, Aitor Azkarate1, Asunción Díaz-Serrano1, Ana Fernández Montes1, Fernando Rivera1. 1. From Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, UMU, IMIB, Murcia, Spain; Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas, Spain; Medical Oncology Department, Hospital General Universitario de Elche, Alicante, Spain; Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain; Hematology and Medical Oncology Department, Hospital Universitario de Ciudad Real, Cuidad Real, Spain; Medical Oncology Department, Hospital Universitario Gregorio Marañón, Madrid, Spain; Medical Oncology Department, Hospital General de Ciudad Real, Ciudad Real, Spain; Medical Oncology Department, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain; Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain; Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain; Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain; Medical Oncology Department, Hospital Galdakao-Usansolo, Usansolo, Spain; Medical Oncology Department, Hospital Universitario del Mar, Barcelona, Spain; Medical Oncology Department, Hospital Clínic, Barcelona, Spain; Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain; Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain; Medical Oncology Department, Complejo Hospitalario de Orense, Spain; and Medical Oncology Department, Hospital Universitario de Valdecilla, Santander, Spain.
Abstract
BACKGROUND: There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. PATIENTS AND METHOD: Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). RESULTS: A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72-0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60-12.68) versus 9.60 months (95% CI, 8.44-10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65-0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64-0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60-1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63-0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. CONCLUSIONS: With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity.
BACKGROUND: There is currently no consensus regarding first-line chemotherapy for patients with advanced gastric cancer (AGC) who are ineligible to receive trastuzumab. The objective of this study was to evaluate the efficacy and tolerance of triplets versus doublets by analyzing a national gastric cancer registry. PATIENTS AND METHOD:Patients with AGC treated with polychemotherapy without associating trastuzumab were included from 2008 through 2016. The effect of triplets versus doublets was compared using 3 methods: Cox proportional hazards regression, propensity score matching (PSM), and coarsened exact matching (CEM). RESULTS: A total of 970 patients were recruited (doublets: n=569; triplets: n=401). In the multivariate Cox model, the use of triplets was associated with better overall survival (OS), with a hazard ratio (HR) of 0.84 (95% CI, 0.72-0.98; P=.035). After PSM, the sample contained 340 pairs. A significant increase in OS, 11.14 months (95% CI, 9.60-12.68) versus 9.60 months (95% CI, 8.44-10.75), was seen in favor of triplets (HR, 0.77; 95% CI, 0.65-0.92; stratified log-rank test, P=.004). The effect appeared to be comparable for anthracycline-based (HR, 0.78; 95% CI, 0.64-0.94) or docetaxel-based triplets (HR, 0.78; 95% CI, 0.60-1.009). The trend was similar after applying the CEM algorithm, with an HR of 0.78 (95% CI, 0.63-0.97; P=.03). Triplet therapy was viable and relative dose intensities exceeded 85%, except for cisplatin in DCX (docetaxel, cisplatin, capecitabine). Triplets had more severe toxicity overall, especially hematologic, hepatic, and mucosal adverse events. CONCLUSIONS: With the limitations of a retrospective study that examines a heterogeneous set of chemotherapy regimens, we found that triplets are feasible in daily practice and are associated with a discreet benefit in efficacy at the expense of a moderate increase in toxicity.
Authors: A Carmona-Bayonas; P Jiménez-Fonseca; A Custodio; M Sánchez Cánovas; R Hernández; C Pericay; I Echavarria; A Lacalle; L Visa; A Rodríguez Palomo; M Mangas; J M Cano; E Buxo; F Álvarez-Manceñido; T García; J E Lorenzo; M Ferrer-Cardona; A Viudez; A Azkarate; A Ramchandani; D Arias; F Longo; C López; R Sánchez Bayona; M L Limón; A Díaz-Serrano; A Fernández Montes; P Sala; P Cerdá; F Rivera; J Gallego Journal: Gastric Cancer Date: 2017-04-09 Impact factor: 7.370
Authors: Sena Valcarcel; Javier Gallego; Paula Jimenez-Fonseca; Marc Diez; Eva Martínez de Castro; Raquel Hernandez; Virginia Arrazubi; Ana Custodio; Juana María Cano; Ana Fernández Montes; Ismael Macias; Laura Visa; Aitana Calvo; Rosario Vidal Tocino; Nieves Martínez Lago; María Luisa Limón; Mónica Granja; Mireia Gil; Paola Pimentel; Lola Macia-Rivas; Carolina Hernández Pérez; Montserrat Mangas; Alfonso Martín Carnicero; Paula Cerdà; Lucía Gomez Gonzalez; Francisco Garcia Navalon; Mª Dolores Mediano Rambla; Marta Martin Richard; Alberto Carmona-Bayonas Journal: J Cancer Res Clin Oncol Date: 2022-08-30 Impact factor: 4.322
Authors: J Gallego Plazas; A Arias-Martinez; A Lecumberri; E Martínez de Castro; A Custodio; J M Cano; R Hernandez; A F Montes; I Macias; A Pieras-Lopez; M Diez; L Visa; R V Tocino; N Martínez Lago; M L Limón; M Gil; P Pimentel; M Mangas; M Granja; A M Carnicero; C Hernández Pérez; L G Gonzalez; P Jimenez-Fonseca; A Carmona-Bayonas Journal: ESMO Open Date: 2022-06-14
Authors: A Viúdez; A Carmona-Bayonas; J Gallego; A Lacalle; R Hernández; J M Cano; I Macías; A Custodio; E Martínez de Castro; A Sánchez; L Iglesia; P Reguera; L Visa; A Azkarate; M Sánchez-Cánovas; M Mangas; M L Limón; A Martínez-Torrón; E Asensio; A Ramchandani; A Martín-Carnicero; A Hurtado; P Cerdà; M Garrido; R Sánchez-Bayonas; R Serrano; P Jiménez-Fonseca Journal: Clin Transl Oncol Date: 2019-08-05 Impact factor: 3.405
Authors: A Custodio; A Carmona-Bayonas; P Jiménez-Fonseca; M L Sánchez; A Viudez; R Hernández; J M Cano; I Echavarria; C Pericay; M Mangas; L Visa; E Buxo; T García; A Rodríguez Palomo; F Álvarez Manceñido; A Lacalle; I Macias; A Azkarate; A Ramchandani; A Fernández Montes; C López; F Longo; R Sánchez Bayona; M L Limón; A Díaz-Serrano; A Hurtado; R Madero; C Gómez; J Gallego Journal: Br J Cancer Date: 2017-05-02 Impact factor: 7.640
Authors: Paula Jiménez Fonseca; Alberto Carmona-Bayonas; Raquel Hernández; Ana Custodio; Juana Maria Cano; Alejandra Lacalle; Isabel Echavarria; Ismael Macias; Monserrat Mangas; Laura Visa; Elvira Buxo; Felipe Álvarez Manceñido; Antonio Viudez; Carles Pericay; Aitor Azkarate; Avinash Ramchandani; Carlos López; Eva Martinez de Castro; Ana Fernández Montes; Federico Longo; Rodrigo Sánchez Bayona; Maria Luisa Limón; Asun Diaz-Serrano; Alfonso Martin Carnicero; David Arias; Paula Cerdà; Fernando Rivera; Jose Maria Vieitez; Manuel Sánchez Cánovas; M Garrido; J Gallego Journal: Br J Cancer Date: 2017-08-01 Impact factor: 7.640
Authors: Almudena Cotes Sanchís; Javier Gallego; Raquel Hernandez; Virginia Arrazubi; Ana Custodio; Juana María Cano; Gema Aguado; Ismael Macias; Carlos Lopez; Flora López; Laura Visa; Marcelo Garrido; Nieves Martínez Lago; Ana Fernández Montes; María Luisa Limón; Aitor Azkárate; Paola Pimentel; Pablo Reguera; Avinash Ramchandani; Juan Diego Cacho; Alfonso Martín Carnicero; Mónica Granja; Marta Martín Richard; Carolina Hernández Pérez; Alicia Hurtado; Olbia Serra; Elvira Buxo; Rosario Vidal Tocino; Paula Jimenez-Fonseca; Alberto Carmona-Bayonas Journal: PLoS One Date: 2020-07-31 Impact factor: 3.240