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Research Article
Takaaki Arigami
Kagoshima University
Corresponding Author
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Background: The Japanese Gastric Cancer Treatment Guidelines 2018 have recommended first- to third-line treatment regimens after nivolumab approval for unresectable advanced gastric cancer. However, the clinical impact of chemotherapeutic changes, including post-progression chemotherapy (PPC), remains unclear. Therefore, the current study aimed to investigate changes in PPC before and after nivolumab approval and determine their prognostic impact.
Methods: A total of 146 patients with unresectable gastric cancer who had at least progressive disease after first- and/or second-line chemotherapy were retrospectively enrolled. All patients were divided into two groups based on the nivolumab approval period.
Results: Among the 146 patients, 46 and 23 received ramucirumab and nivolumab, respectively. Moreover, 95 and 62 patients received PPC after first- and second-line chemotherapy, respectively. Group B (i.e., at least chemotherapy after nivolumab approval) had significantly higher proportions of patients receiving ramucirumab therapy, nivolumab therapy, and PPC after first- or second-line chemotherapy compared to group A (i.e., termination of chemotherapy before nivolumab approval) (all p < 0.0001). Group A had significantly poorer prognosis than group B (p = 0.0002). Multivariate analysis showed that age (< 70 vs. ³ 70), number of distant metastatic sites (1 vs. ³ 2), and ramucirumab therapy were independent prognostic factors (p = 0.0252, p = 0.0036, and p = 0.0076, respectively).
Conclusion: Our retrospective study demonstrated that changes in chemotherapeutic strategy might contribute to improved prognosis in patients with advanced gastric cancer.
Keywords
Post-progression chemotherapy, Ramucirumab, Nivolumab, Prognosis, Gastric cancer
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No competing interests reported.
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This preprint is under consideration at BMC Gastroenterology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Takaaki Arigami
Kagoshima University
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 22 Feb, 2021
No community comments so far
Reviews received
Received 11 May, 2021
Reviewers agreed
On 27 Apr, 2021
Reviews received
Received 07 Mar, 2021
Reviewers agreed
On 17 Feb, 2021
Reviewers invited
Invitations sent on 16 Feb, 2021
Editor assigned
On 14 Feb, 2021
Editor invited
On 14 Feb, 2021
Submission checks complete
On 14 Feb, 2021
First submitted
On 06 Feb, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Gastroenterology & Hepatology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background: The Japanese Gastric Cancer Treatment Guidelines 2018 have recommended first- to third-line treatment regimens after nivolumab approval for unresectable advanced gastric cancer. However, the clinical impact of chemotherapeutic changes, including post-progression chemotherapy (PPC), remains unclear. Therefore, the current study aimed to investigate changes in PPC before and after nivolumab approval and determine their prognostic impact.
Methods: A total of 146 patients with unresectable gastric cancer who had at least progressive disease after first- and/or second-line chemotherapy were retrospectively enrolled. All patients were divided into two groups based on the nivolumab approval period.
Results: Among the 146 patients, 46 and 23 received ramucirumab and nivolumab, respectively. Moreover, 95 and 62 patients received PPC after first- and second-line chemotherapy, respectively. Group B (i.e., at least chemotherapy after nivolumab approval) had significantly higher proportions of patients receiving ramucirumab therapy, nivolumab therapy, and PPC after first- or second-line chemotherapy compared to group A (i.e., termination of chemotherapy before nivolumab approval) (all p < 0.0001). Group A had significantly poorer prognosis than group B (p = 0.0002). Multivariate analysis showed that age (< 70 vs. ³ 70), number of distant metastatic sites (1 vs. ³ 2), and ramucirumab therapy were independent prognostic factors (p = 0.0252, p = 0.0036, and p = 0.0076, respectively).
Conclusion: Our retrospective study demonstrated that changes in chemotherapeutic strategy might contribute to improved prognosis in patients with advanced gastric cancer.
Figure 1
Figure 2
No competing interests reported.
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