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Treatment features of systemic chemotherapy in young adults with unresectable advanced or recurrent gastric cancer

Authors Nakayama I, Chin K, Takahari D, Ogura M, Ichimura T, Wakatsuki T, Osumi H, Ota Y, Suzuki T, Suenaga M, Shinozaki E, Yamaguchi K

Received 5 July 2018

Accepted for publication 11 September 2018

Published 1 November 2018 Volume 2018:10 Pages 5283—5290

DOI https://doi.org/10.2147/CMAR.S179219

Checked for plagiarism Yes

Review by Single-blind

Peer reviewers approved by Dr Cristina Weinberg

Peer reviewer comments 2

Editor who approved publication: Professor Nakshatri


Izuma Nakayama, Keisho Chin, Daisuke Takahari, Mariko Ogura, Takashi Ichimura, Takeru Wakatsuki, Hiroki Osumi, Yumiko Ota, Takeshi Suzuki, Mitsukuni Suenaga, Eiji Shinozaki, Kensei Yamaguchi

Department of Gastroenterological Chemotherapy, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan

Purpose: Gastric cancer in young adults (GCYA) is known to have distinct clinicopathological features, including a female predominance and diffuse-type histology. Previous reports have focused on patients who had undergone gastrectomy with curative intent. Information concerning the treatment of unresectable advanced- or recurrent-stage GCYA is lacking. Therefore, we aimed to investigate whether the distinct clinicopathological features of GCYA affect the outcome of systemic chemotherapy.
Patients and methods: We conducted a retrospective cohort study at a single institution in Japan. GCYA was classified as a disease in individuals who were <40 years of age at diagnosis. Initial systemic chemotherapy regimens for GCYA were investigated with a focus on patients who received S-1 plus cisplatin (SP) as a representative standard regimen. The efficacy, safety, and feasibility of systemic chemotherapy were evaluated.
Results: Eighty-nine (7.5%) of 1,184 consecutive patients who received systemic chemotherapy at our institute between December 2005 and June 2016 were enrolled. As reported previously, the female sex (57.3%) and diffuse-type histology (91.0%) were the dominant features of GCYA. Thirty-two patients (36.0%) received SP as first-line treatment. The median overall survival and progression-free survival times were 13.2 (95.0% CI: 9.5–18.7) and 5.6 (95.0% CI: 4.7–7.9) months, respectively. The median number of treatment cycles, relative dose intensity, and cumulative dose of cisplatin were 4.5 (range: 1–10), 92.0% (IQR: 83.5–98.3), and 286.5 mg/m2 (IQR: 172.5–367.5), respectively. The most common adverse event of Grade 3 or higher was neutropenia (n=5 patients; 15.6%). No patient had febrile neutropenia. Non-hematological adverse events of Grade 3 or higher were only observed in 2 (6.3%) of 32 patients.
Conclusion: Standard chemotherapy used for general-aged GC patients has similar efficacy, reduced toxicity, and higher intensity in GCYA patients.

Keywords: efficacy, S-1 plus cisplatin, younger patients

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