Clinical Impact of Oral Intake in Second-line or Third-line Chemotherapy for 589 Patients With Advanced Gastric Cancer: A Retrospective Cohort Study. (August 2021)

• Record Type: Journal Article
• Authors: Ogata, Takatsugu; Narita, Yukiya; Kumanishi, Ryosuke; Nakazawa, Taiko; Matsubara, Yuki; Kato, Kyoko; Nozawa, Kazuki; Honda, Kazunori; Masuishi, Toshiki; Bando, Hideaki; Kadowaki, Shigenori; Ando, Masashi; Tajika, Masahiro; Muro, Kei
• Is Part Of: American journal of clinical oncology. Volume 44:Number 8(2021)
• Publication Date: 2021-08
• Subjects: gastric cancer -- chemotherapy -- eating -- disease progression; Cancer -- Treatment -- Periodicals; Oncology -- Periodicals; Tumors -- Periodicals; 616.994005
• DOI: 10.1097/COC.0000000000000835
• Languages: English
• ISSNs: 0277-3732

Abstract

Abstract : Objectives: Insufficient oral intake in advanced gastric cancer (AGC) limits the use of several drugs. We aimed to determine the oral intake status of patients with AGC during later-line chemotherapy. Materials and Methods: We retrospectively evaluated data of patients with AGC who experienced disease progression during first-line chemotherapy administered from January 2012 to December 2018 in a single institution. We defined "insufficient oral intake" as requiring daily intravenous fluids or hyperalimentation. Multivariate logistic regression was performed to identify oral intake-related factors. Results: Among 589 included patients, at disease progression during first-line, second-line, and third-line chemotherapy, 78.3% (461), 53.3% (314), and 30.4% (179) of patients, respectively, exhibited sufficient oral intake. Fourth-line chemotherapy was initiated for 22.2% (131) of patients, with 20.0% (118) exhibiting sufficient oral intake. During second-line and third-line chemotherapy, 11/67 (16%) and 2/39 (5%) patients, respectively, exhibited improvements in oral intake; 85/428 (19.9%) and 70/259 (27.0%), respectively, exhibited deteriorations in oral intake. Factors correlated to deterioration in oral intake during second-line chemotherapy were poor Eastern Cooperative Oncology Group Performance Status (odds ratio, 4.32; P <0.001), moderate or severe ascites (1.96; P =0.045), peritoneal metastasis (2.12; P =0.029), prior palliative surgery (3.41; P =0.003), and high neutrophil-to-lymphocyte ratio (3.09; P <0.001); those correlated to deterioration in oral intake during third-line chemotherapy were poorly differentiated pathology (2.52; P =0.025) and high neutrophil-to-lymphocyte ratio (2.65; P =0.006). Conclusion: As later-line chemotherapy is ineffective in improving oral intake in patients with AGC, careful adaptation of regimens is required for patients at risk for impaired oral intake. Abstract : Supplemental Digital Content is available in the text.