Impact of Clinical Response to First-Line Chemotherapy on Gastric Cancer Patients Treated with Second-Line and Third-Line Chemotherapy

Background/Aims: A combination regimen of up to three cytotoxic agents have been delivered in the West whereas single agent or two-drug combination regimens have been used sequentially in Japan for patients with unresectable/recurrent gastric cancer. Patients treated with chemotherapy in a single Japanese institution were analyzed to identify patients who benefit from higher lines of chemotherapy. Methodology: A prospective database was searched for patients with advanced/recurrent gastric carcinoma Who underwent chemotherapy between 2002 and 2008. When the front line treatment failed, further therapy was offered unless performance status (PS) was >2 or when the patient declined to receive further treatment. The clinical tumor response and overall survival after each line of treatment were assessed. Results: Sixty-four consecutive patients were identified, of which 46 patients (72%) underwent second-line chemotherapy and 22 (34%) underwent third-line. Disease stabilization (best overall response of other than PD) and positive cytological examination (CY1) as a sole cause of non-curative resection were identified as indicators of long survival after the first-line therapy. Disease stabilization observed at the first-line therapy was found to be a significant predictor of survival after initiation of the second-line and third-line therapies. Conclusions: The current study delineates that the response to the first-line treatment can be used to predict the effect of higher lines of treatment.