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C-reactive protein predicts recurrence after postoperative chemotherapy using S-1 in advanced gastric cancer patients
abstracts
P3 029
Nab-paclitaxel plus ramucirumab combination therapy as secondline with advanced gastric cancer:Retrospective study
Tomomi Kashiwada, Atsujiro Nishioka, Kazutoshi Komiya, Naoko Aragane, Shinya Kimura Department of Internal Medicine, Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University Background: Metastatic advanced gastric cancer(AGC) is predominantly a disease in JAPAN. A Phase II trial show the efficacy and safety of nab-paclitaxel plus ramucirumab combination therapy for previously treated advanced gastric cancer but the benefits of second-line chemotherapy in real world including elderly patients remain uncertain. Methods: We retrospectively examined pts with AGC who were treated in Saga-university hospital. The key inclusion criteria were ECOG PS 0-2 and refractory/intolerant to first line treatments. The objective was the efficacy of Ramucirumab plus nab-Paclitaxel as second-line therapy in real-world patients with AGC. Results: A total of 14 patients underwent second-line chemotherapy for gastric cancer between 2017 and 2018 at our hospital. We evaluated the outcome in terms of median progressive free survival (PFS) and overall survival (OS) respectively. The ORR assessed was 40.0% and the DCR was 100%. The median PFS was 7.6 months (95% CI 2.1-17.5). The median OS was not reached at the data cutoff. The main treatment-related over grade 2 adverse events were decreased neutrophil count (60%),hypertension (26%) and proteinuria (0%). Conclusions: Nab-paclitaxel plus ramucirumab combination therapy shows similar treatment results to the Phase II study and toxicities were safety manageable. This treatment regimen could be a useful second line treatment option for patients with previously treated AGC.
P3 030
C-reactive protein predicts recurrence after postoperative chemotherapy using S-1 in advanced gastric cancer patients
Takayuki Shimizu, Mitsuru Ishizuka, Takao Arakawa, Takashi Suzuki, Kazuma Tago, Hiroyuki Hachiya, Yasuhiro Harada, Kyunghwa Park, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Akihito Abe, Yukihiro Iso, Kazutoshi Takagi, Taku Aoki, Keiichi Kubota Second Department of Surgery, Dokkyo Medical University Background&Aim: According to the Japanese gastric cancer treatment guidelines, postoperative adjuvant chemotherapy (PAC) using S-1 is recommended for patients undergoing curative surgery for advanced gastric cancer (GC). Recently, new chemotherapeutic regimens such as S-1 plus oxaliplatin and capecitabine plus oxaliplatin were reported to be applicable and safe as new PAC for stage II and III of GC patients. Although the option of PAC has been increased, it is still unclear how to choose the best regimen of PAC for advanced GC patients. Therefore, we aimed to investigate the clinical characteristics which are closely associated with the recurrence of GC in patients with PAC using S-1. Methods: Thirty-nine patients who received PAC using S-1 more than 1 year after curative surgery for advanced GC from March 2005 to December 2017 were enrolled. Univariate and multivariate analyses using the Cox proportional hazard model were performed to detect clinical characteristics that correlated with recurrence, and their cut-off values were identified using receiver operating characteristic (ROC) curve analyses to divide patients into two groups such as recurrence and non-recurrence group. Kaplan-Meier analysis and log-rank test were used for comparison of relapse-free survival (RFS). Results: Sixteen patients had recurrence after surgery (41%, 16/39). Multivariate analysis using clinical characteristics selected by univariate analyses revealed that C-reactive protein (>0.3/0.3, mg/dL) (hazard ratio [HR], 10.73; 95% CI, 1.824-63.14; P ¼ 0.009) was significantly associated with recurrence. Kaplan-Meier analysis and logrank test demonstrated that C-reactive protein (>0.3/0.3, mg/dL) was also significantly associated with RFS (P < 0.001).
vi140 | Poster Session
Conclusion: C-reactive protein is significantly associated with recurrence of GC in patients with PAC using S-1 after curative surgery.
P3 036
The clinicopathological features of long-term survivors of metastatic gastric cancer
Kenji Ina1, Ryuichi Furuta1, Megumi Kabeya2, Satoshi Hibi2, Shu Yuasa2, Yuko Kato3, Takashi Yoshida4, Takae Kataoka4, Satoshi Kayukawa4 1 Department of Medical Oncology, Nagoya Memorial Hospital, 2Department of Hospital Pharmacy, Nagoya Memorial Hospital, 3Medical Social Work Consultation Room, Nagoya Memorial Hospital, 4Department of Clinical Oncology, Nagoya Memorial Hospital Background: Metastatic gastric cancer has a poor prognosis. Overall survival in these patients is approximately 1 years, despite the development of chemotherapeutic and biological agents. The incidence of long-term survivors of metastatic gastric cancer beyond 5 years after the initiation of chemotherapy has been reported to be less than 10%. Methods: The characteristics of long-term survivors were compared with those of poor responders to determine the specific factors that regulate chemosensitivity. Those who died within six months after the initiation of chemotherapy were considered as poor responders in this analysis. Medical records were retrospectively reviewed to determine the clinicopathological features of metastatic gastric cancer patients receiving chemotherapy in Nagoya Memorial Hospital. Statistical analyses were carried out by Fisher’s exact test and then a multivariate analysis. Differences with P values less than 0.05 were considered statistically significant. The chart review was approved by ethics committee of Nagoya Memorial Hospital. Results: We experienced 8 long-term survivors and 12 poor responders. The analysis showed that number of metastatic sites might be different between 2 groups (P ¼ 0.0144). The objective response rates of long-term survivors and poor responders were 62.5% (CR 4, PR 1) and 0%, respectively. Conclusions: We found that tumor burden might be associated with the prognosis of affected patients. Good response to systemic chemotherapy should be essential for prolonged survival of patients with distant metastases.
P3 057
Treatment Outcomes after Pulmonary Stereotactic Body Radiotherapy for Oligometastatic or Oligorecurrent Lung Lesions
Brendan Sh Chia Radiation Oncology Department, National Cancer Centre Singapore, Singapore Objective: Using ablative techniques like stereotactic body radiation therapy (SBRT) in patients with limited metastases may improve survival outcomes in select groups of patients. We review the outcomes of patients treated with oligometastatic/recurrent lung lesions in our centre and analyse variables that might have affected them. Methods: A retrospective review of patients treated from Jan 2010 to Dec 2016 was conducted. The data was analysed using SPSS ver23. Results: A total of 46 patients with 51 lung lesions were treated with SBRT. Majority of lesions were of lung and colorectal cancers. Histological confirmation was obtained in 50%. Median SBRT biological effective dose (BED) was 105.6Gy and median follow-up was 26.9 months. There were 12 (22.6%) local failures at last follow-up. Median progression free survival (PFS) was 13.7 months (95% CI: 3.9 -23.5 months). Median overall survival (OS) was 42.2 months (95% CI: 30.8 - 53.5 months). The 2 year PFS and OS was 32.6% and 81.9% respectively. There were 3 (6.5%) likely radiotherapy related grade 3-4 pulmonary toxicities. On univariate analysis, local control rates were better with a higher BED and in squamous cell histology. Progression free survival was better for patients with metachronous lesions, higher BED, controlled primary lesions and when treatment to all visible lesions was given. Only patients with solitary metastatic lesions had better OS (44.7 months) and PFS (21.9 months) on univariate analysis. Local failure and progression predicted for worst OS. Conclusion: The patients in this study are heterogeneous. Survival outcomes were better in patients with solitary metastatic lesions. This may be due to selection of patients with indolent disease biology. Better PFS were seen with higher BED and when all visible lesions were ablated. Further studies are needed.
P3 061
Comparative study on safety after primary and secondary treatment in EGFR positive NSCLC administered Osimertinib
Kengo Umehara1, Keisuke Gto1, Yuki Okayama1, Shiori Noomote1, Takayuki Toda1, Yasuka Okazaki1, Azusa Wakamoto1, Tae Hatsuyama1, Osamu Honjo2, Hideki Sato3 1 Sapporo minami sanjo hospital pharmaceutical department, 2Sapporo minami sanjo hospital respiratory medicine department, 3Hokkaido university of science pharmacy department of pharmacy department of clinical pharmacology major Background: Since osimertinib significantly prolonged progression free survival compared with conventional EGFR-TKI and was well-tolerated, it was approved in August
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz343.104/5583055 by guest on 28 October 2019
Methods: We have retrospectively reviewed data of all patients in metastatic gastric cancer who received chemotherapy in our hospital and investigated the efficacy and adverse events of chemotherapy after progression on nivolumab. Results: Between September 2017 and January 2019, 29 patients received nivolumab for metastatic gastric cancer. 11 patients received subsequent treatment following nivolumab. The median age was 70. Performance status (0/1/2); 2/8/1. Previous treatment regimens (2/3/4/5); 4/3/2/1. Chemotherapy regimen (irinotecan / nab-paclitaxel6ramcirumab / CAPOX6trastuzumab / SOXþtrastuzumab); 3/5/2/1. Overall Response rate was 27%. 2 patients for nab-PTXþramcirumab and 1patient of CAPOXþtrastuzumab had a PR, 1patient for nab-PTXþramcirumab had a SD, 5 patients had a PD and 1 patient had a NE. Median PFS was 3.3 (95% CI. 0.8-5.5) months. Median OS was 8.0 (95%CI. 2.3-11.6) months. One patient developed Gr3 dysfunction of liver maybe due to nivolumab. Other adverse events were mild. Conclusions: We evaluated the efficacy of chemotherapy after progression on nivolumab. Further investigation is warranted to reveal an immunotherapy-induced chemosensitization effect.
Annals of Oncology
P3 029
Nab-paclitaxel plus ramucirumab combination therapy as secondline with advanced gastric cancer:Retrospective study
Tomomi Kashiwada, Atsujiro Nishioka, Kazutoshi Komiya, Naoko Aragane, Shinya Kimura Department of Internal Medicine, Division of Hematology, Respiratory Medicine and Oncology, Faculty of Medicine, Saga University Background: Metastatic advanced gastric cancer(AGC) is predominantly a disease in JAPAN. A Phase II trial show the efficacy and safety of nab-paclitaxel plus ramucirumab combination therapy for previously treated advanced gastric cancer but the benefits of second-line chemotherapy in real world including elderly patients remain uncertain. Methods: We retrospectively examined pts with AGC who were treated in Saga-university hospital. The key inclusion criteria were ECOG PS 0-2 and refractory/intolerant to first line treatments. The objective was the efficacy of Ramucirumab plus nab-Paclitaxel as second-line therapy in real-world patients with AGC. Results: A total of 14 patients underwent second-line chemotherapy for gastric cancer between 2017 and 2018 at our hospital. We evaluated the outcome in terms of median progressive free survival (PFS) and overall survival (OS) respectively. The ORR assessed was 40.0% and the DCR was 100%. The median PFS was 7.6 months (95% CI 2.1-17.5). The median OS was not reached at the data cutoff. The main treatment-related over grade 2 adverse events were decreased neutrophil count (60%),hypertension (26%) and proteinuria (0%). Conclusions: Nab-paclitaxel plus ramucirumab combination therapy shows similar treatment results to the Phase II study and toxicities were safety manageable. This treatment regimen could be a useful second line treatment option for patients with previously treated AGC.
P3 030
C-reactive protein predicts recurrence after postoperative chemotherapy using S-1 in advanced gastric cancer patients
Takayuki Shimizu, Mitsuru Ishizuka, Takao Arakawa, Takashi Suzuki, Kazuma Tago, Hiroyuki Hachiya, Yasuhiro Harada, Kyunghwa Park, Takayuki Shiraki, Yuhki Sakuraoka, Shozo Mori, Akihito Abe, Yukihiro Iso, Kazutoshi Takagi, Taku Aoki, Keiichi Kubota Second Department of Surgery, Dokkyo Medical University Background&Aim: According to the Japanese gastric cancer treatment guidelines, postoperative adjuvant chemotherapy (PAC) using S-1 is recommended for patients undergoing curative surgery for advanced gastric cancer (GC). Recently, new chemotherapeutic regimens such as S-1 plus oxaliplatin and capecitabine plus oxaliplatin were reported to be applicable and safe as new PAC for stage II and III of GC patients. Although the option of PAC has been increased, it is still unclear how to choose the best regimen of PAC for advanced GC patients. Therefore, we aimed to investigate the clinical characteristics which are closely associated with the recurrence of GC in patients with PAC using S-1. Methods: Thirty-nine patients who received PAC using S-1 more than 1 year after curative surgery for advanced GC from March 2005 to December 2017 were enrolled. Univariate and multivariate analyses using the Cox proportional hazard model were performed to detect clinical characteristics that correlated with recurrence, and their cut-off values were identified using receiver operating characteristic (ROC) curve analyses to divide patients into two groups such as recurrence and non-recurrence group. Kaplan-Meier analysis and log-rank test were used for comparison of relapse-free survival (RFS). Results: Sixteen patients had recurrence after surgery (41%, 16/39). Multivariate analysis using clinical characteristics selected by univariate analyses revealed that C-reactive protein (>0.3/0.3, mg/dL) (hazard ratio [HR], 10.73; 95% CI, 1.824-63.14; P ¼ 0.009) was significantly associated with recurrence. Kaplan-Meier analysis and logrank test demonstrated that C-reactive protein (>0.3/0.3, mg/dL) was also significantly associated with RFS (P < 0.001).
vi140 | Poster Session
Conclusion: C-reactive protein is significantly associated with recurrence of GC in patients with PAC using S-1 after curative surgery.
P3 036
The clinicopathological features of long-term survivors of metastatic gastric cancer
Kenji Ina1, Ryuichi Furuta1, Megumi Kabeya2, Satoshi Hibi2, Shu Yuasa2, Yuko Kato3, Takashi Yoshida4, Takae Kataoka4, Satoshi Kayukawa4 1 Department of Medical Oncology, Nagoya Memorial Hospital, 2Department of Hospital Pharmacy, Nagoya Memorial Hospital, 3Medical Social Work Consultation Room, Nagoya Memorial Hospital, 4Department of Clinical Oncology, Nagoya Memorial Hospital Background: Metastatic gastric cancer has a poor prognosis. Overall survival in these patients is approximately 1 years, despite the development of chemotherapeutic and biological agents. The incidence of long-term survivors of metastatic gastric cancer beyond 5 years after the initiation of chemotherapy has been reported to be less than 10%. Methods: The characteristics of long-term survivors were compared with those of poor responders to determine the specific factors that regulate chemosensitivity. Those who died within six months after the initiation of chemotherapy were considered as poor responders in this analysis. Medical records were retrospectively reviewed to determine the clinicopathological features of metastatic gastric cancer patients receiving chemotherapy in Nagoya Memorial Hospital. Statistical analyses were carried out by Fisher’s exact test and then a multivariate analysis. Differences with P values less than 0.05 were considered statistically significant. The chart review was approved by ethics committee of Nagoya Memorial Hospital. Results: We experienced 8 long-term survivors and 12 poor responders. The analysis showed that number of metastatic sites might be different between 2 groups (P ¼ 0.0144). The objective response rates of long-term survivors and poor responders were 62.5% (CR 4, PR 1) and 0%, respectively. Conclusions: We found that tumor burden might be associated with the prognosis of affected patients. Good response to systemic chemotherapy should be essential for prolonged survival of patients with distant metastases.
P3 057
Treatment Outcomes after Pulmonary Stereotactic Body Radiotherapy for Oligometastatic or Oligorecurrent Lung Lesions
Brendan Sh Chia Radiation Oncology Department, National Cancer Centre Singapore, Singapore Objective: Using ablative techniques like stereotactic body radiation therapy (SBRT) in patients with limited metastases may improve survival outcomes in select groups of patients. We review the outcomes of patients treated with oligometastatic/recurrent lung lesions in our centre and analyse variables that might have affected them. Methods: A retrospective review of patients treated from Jan 2010 to Dec 2016 was conducted. The data was analysed using SPSS ver23. Results: A total of 46 patients with 51 lung lesions were treated with SBRT. Majority of lesions were of lung and colorectal cancers. Histological confirmation was obtained in 50%. Median SBRT biological effective dose (BED) was 105.6Gy and median follow-up was 26.9 months. There were 12 (22.6%) local failures at last follow-up. Median progression free survival (PFS) was 13.7 months (95% CI: 3.9 -23.5 months). Median overall survival (OS) was 42.2 months (95% CI: 30.8 - 53.5 months). The 2 year PFS and OS was 32.6% and 81.9% respectively. There were 3 (6.5%) likely radiotherapy related grade 3-4 pulmonary toxicities. On univariate analysis, local control rates were better with a higher BED and in squamous cell histology. Progression free survival was better for patients with metachronous lesions, higher BED, controlled primary lesions and when treatment to all visible lesions was given. Only patients with solitary metastatic lesions had better OS (44.7 months) and PFS (21.9 months) on univariate analysis. Local failure and progression predicted for worst OS. Conclusion: The patients in this study are heterogeneous. Survival outcomes were better in patients with solitary metastatic lesions. This may be due to selection of patients with indolent disease biology. Better PFS were seen with higher BED and when all visible lesions were ablated. Further studies are needed.
P3 061
Comparative study on safety after primary and secondary treatment in EGFR positive NSCLC administered Osimertinib
Kengo Umehara1, Keisuke Gto1, Yuki Okayama1, Shiori Noomote1, Takayuki Toda1, Yasuka Okazaki1, Azusa Wakamoto1, Tae Hatsuyama1, Osamu Honjo2, Hideki Sato3 1 Sapporo minami sanjo hospital pharmaceutical department, 2Sapporo minami sanjo hospital respiratory medicine department, 3Hokkaido university of science pharmacy department of pharmacy department of clinical pharmacology major Background: Since osimertinib significantly prolonged progression free survival compared with conventional EGFR-TKI and was well-tolerated, it was approved in August
Volume 30 | Supplement 6 | October 2019
Downloaded from https://academic.oup.com/annonc/article-abstract/30/Supplement_6/mdz343.104/5583055 by guest on 28 October 2019
Methods: We have retrospectively reviewed data of all patients in metastatic gastric cancer who received chemotherapy in our hospital and investigated the efficacy and adverse events of chemotherapy after progression on nivolumab. Results: Between September 2017 and January 2019, 29 patients received nivolumab for metastatic gastric cancer. 11 patients received subsequent treatment following nivolumab. The median age was 70. Performance status (0/1/2); 2/8/1. Previous treatment regimens (2/3/4/5); 4/3/2/1. Chemotherapy regimen (irinotecan / nab-paclitaxel6ramcirumab / CAPOX6trastuzumab / SOXþtrastuzumab); 3/5/2/1. Overall Response rate was 27%. 2 patients for nab-PTXþramcirumab and 1patient of CAPOXþtrastuzumab had a PR, 1patient for nab-PTXþramcirumab had a SD, 5 patients had a PD and 1 patient had a NE. Median PFS was 3.3 (95% CI. 0.8-5.5) months. Median OS was 8.0 (95%CI. 2.3-11.6) months. One patient developed Gr3 dysfunction of liver maybe due to nivolumab. Other adverse events were mild. Conclusions: We evaluated the efficacy of chemotherapy after progression on nivolumab. Further investigation is warranted to reveal an immunotherapy-induced chemosensitization effect.
Annals of Oncology