A Viúdez1, A Carmona-Bayonas2, J Gallego3, A Lacalle4, R Hernández5, J M Cano6, I Macías7, A Custodio8, E Martínez de Castro9, A Sánchez10, L Iglesia11, P Reguera12, L Visa13, A Azkarate14, M Sánchez-Cánovas15, M Mangas16, M L Limón17, A Martínez-Torrón18, E Asensio3, A Ramchandani19, A Martín-Carnicero20, A Hurtado21, P Cerdà22, M Garrido23, R Sánchez-Bayonas24, R Serrano25, P Jiménez-Fonseca26. 1. Medical Oncology Department, Complejo Hospitalario de Navarra (CHN), OncobionaTras Unit, Navarrabiomed, Navarrabiomed Biomedical Center, IdiSNA, Irunlarrea 3, 31008, Pamplona, Navarra, Spain. aviudez@outlook.es. 2. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain. 3. Medical Oncology Department, Hospital Universitario de Elche, Elche, Spain. 4. Medical Oncology Department, Complejo Hospitalario de Navarra, Pamplona, Spain. 5. Medical Oncology Department, Hospital Universitario de Canarias, Tenerife, Spain. 6. Medical Oncology Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain. 7. Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain. 8. Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain. 9. Medical Oncology Department, Hospital Universitario Marqués de Valdecilla, Santander, Spain. 10. Medical Oncology Department, Hospital Universitario Doce de Octubre, Madrid, Spain. 11. Medical Oncology Department, Complejo Hospitalario de Orense, Orense, Spain. 12. Medical Oncology Department, Hospital Universitario Ramón Y Cajal, Madrid, Spain. 13. Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain. 14. Medical Oncology Department, Hospital Universitario Son Espases, Mallorca, Spain. 15. Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, Murcia, Spain. 16. Medical Oncology Department, Hospital Galdakao-Usansolo, Galdakao-Usansolo, Spain. 17. Medical Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain. 18. Pharmacy Department, Hospital Universitario Central de Asturias, Oviedo, Spain. 19. Medical Oncology Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain. 20. Medical Oncology Department, Complejo Hospitalario San Millán, Logroño, Spain. 21. Medical Oncology Department, Hospital Universitario Fundación Alcorcón, Madrid, Spain. 22. Medical Oncology Department, Centro Médico Tecknon, Barcelona, Spain. 23. Medical Oncology Department, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile. 24. Medical Oncology Department, Clínica Universidad de Navarra, Pamplona, Spain. 25. Medical Oncology Department, Hospital Universitario Reina Sofía, Córdoba, Spain. 26. Medical Oncology Department, Hospital Universitario Central de Asturias, Oviedo, Spain.
Abstract
BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
BACKGROUND: The optimal duration of first-line chemotherapy for patients with advanced gastric cancer is unknown. Diverse clinical trials have proposed different strategies including limited treatment, maintenance of some drugs, or treatment until progression. METHOD: The sample comprises patients from the AGAMENON multicenter registry without progression after second evaluation of response. The objective was to explore the optimal duration of first-line chemotherapy. A frailty multi-state model was conducted. RESULTS: 415 patients were divided into three strata: discontinuation of platinum and maintenance with fluoropyrimidine until progression (30%, n = 123), complete treatment withdrawal prior to progression (52%, n = 216), and full treatment until progression (18%, n = 76). The hazard of tumor progression decreased by 19% per month with the full treatment regimen. However, we found no evidence that fluoropyrimidine maintenance (hazard ratio [HR] 1.07, confidence interval [CI] 95%, 0.69-1.65) worsened progression-free survival (PFS) with respect to treatment until progression. Predictive factors for PFS were ECOG performance status, ≥ 3 metastatic sites, prior tumor response, and bone metastases. Toxicity grade 3/4 was more common in those who continued the full treatment until progression vs fluoropyrimidine maintenance (16% vs 6%). CONCLUSION: The longer duration of the full initial regimen exerted a protective effect on the patients of this registry. Platinum discontinuation followed by fluoropyrimidine maintenance yields comparable efficacy to treatment up to PD, with a lower rate of serious adverse events.
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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: 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
Authors: David Zaragoza-Huesca; Pedro Garrido-Rodríguez; Paula Jiménez-Fonseca; Eva Martínez de Castro; Manuel Sánchez-Cánovas; Laura Visa; Ana Custodio; Ana Fernández-Montes; Julia Peñas-Martínez; Patricia Morales Del Burgo; Javier Gallego; Ginés Luengo-Gil; Vicente Vicente; Irene Martínez-Martínez; Alberto Carmona-Bayonas Journal: Biomedicines Date: 2022-01-11