Effect of the timing of discontinuation of last‑line chemotherapy on patient prognosis in advanced and recurrent gastric cancer

Kimura,Michio; Kawachi,Shiori; Go,Makiko; Iwai,Mina; Usami,Eiseki; Teramachi,Hitomi; Yoshimura,Tomoaki

doi:10.3892/mco.2018.1753

Effect of the timing of discontinuation of last‑line chemotherapy on patient prognosis in advanced and recurrent gastric cancer

Authors:
- Michio Kimura
- Shiori Kawachi
- Makiko Go
- Mina Iwai
- Eiseki Usami
- Hitomi Teramachi
- Tomoaki Yoshimura
View Affiliations

Affiliations: Department of Pharmacy, Ogaki Municipal Hospital, Ogaki, Gifu 503‑8502, Japan, Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu 501‑1196, Japan
Published online on: October 26, 2018 https://doi.org/10.3892/mco.2018.1753
Pages: 173-179

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

The present study aimed to determine the effect of the timing of treatment discontinuation on the prognosis of patients with advanced and recurrent gastric cancer chemotherapy. Between July 2014 and March 2017, 127 patients who underwent chemotherapy for advanced and recurrent gastric cancer at Ogaki Municipal Hospital (Ogaki, Japan) were examined. To determine factors associated with survival, multivariate analysis using the Cox proportional hazards model, and hazard ratios and their 95% confidence intervals (95% CI) were calculated. The reasons for discontinuation of last‑line chemotherapy and the last hospitalization prior to mortality were surveyed. Age (≤51 years), number of treatment lines (≤1 line), and days between last dose of the final chemotherapy regimen and death (≤79 days) were independently and significantly associated with survival in the multivariate analysis. Compared with patients who did not receive chemotherapy in the last 79 days of life, those who received chemotherapy in the last 79 days of life days had a hazard ratio of 1.858 (95% CI, 1.059‑3.261; P=0.031) for mortality. A decrease in the performance status was responsible for treatment discontinuation in 51 of 75 cases among patients who received chemotherapy in the last 79 days of life and 9 of 26 cases among patients who did not receive chemotherapy in this duration (P<0.001). Among patients who received chemotherapy in the last 79 days of life, 67 patients were hospitalized prior to mortality; among patients who did not receive chemotherapy in this duration, 15 patients were hospitalized prior to mortality (P<0.001). In conclusion, continuation of chemotherapy until just prior to mortality does not prolong the survival time in patients with advanced and recurrent gastric cancer.

View Figures

View References

1	Boku N, Yamamoto S, Fukuda H, Shirao K, Doi T, Sawaki A, Koizumi W, Saito H, Yamaguchi K, Takiuchi H, et al; Gastrointestinal Oncology Study Group of the Japan Clinical Oncology Group, . Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: A randomised phase 3 study. Lancet Oncol. 10:1063–1069. 2009. View Article : Google Scholar : PubMed/NCBI
2	Koizumi W, Narahara H, Hara T, Takagane A, Akiya T, Takagi M, Miyashita K, Nishizaki T, Kobayashi O, Takiyama W, et al: S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): A phase III trial. Lancet Oncol. 9:215–221. 2008. View Article : Google Scholar : PubMed/NCBI
3	Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, Lordick F, Ohtsu A, Omuro Y, Satoh T, et al; ToGA Trial Investigators, . Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): A phase 3, open-label, randomised controlled trial. Lancet. 376:687–697. 2010. View Article : Google Scholar : PubMed/NCBI
4	Ohtsu A, Shah MA, Van Cutsem E, Rha SY, Sawaki A, Park SR, Lim HY, Yamada Y, Wu J, Langer B, et al: Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: A randomized, double-blind, placebo-controlled phase III study. J Clin Oncol. 29:3968–3976. 2011. View Article : Google Scholar : PubMed/NCBI
5	Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, Middleton G, Daniel F, Oates J and Norman AR; Upper Gastrointestinal Clinical Studies Group of the National Cancer Research Institute of the United Kingdom, . Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 358:36–46. 2008. View Article : Google Scholar : PubMed/NCBI
6	Yamada Y, Higuchi K, Nishikawa K, Gotoh M, Fuse N, Sugimoto N, Nishina T, Amagai K, Chin K, Niwa Y, et al: Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol. 26:141–148. 2015. View Article : Google Scholar : PubMed/NCBI
7	Shah MA, Bang YJ, Lordick F, Alsina M, Chen M, Hack SP, Bruey JM, Smith D, McCaffery I, Shames DS, et al: Effect of fluorouracil, leucovorin, and oxaliplatin with or without onartuzumab in HER2-negative, MET-positive gastroesophageal adenocarcinoma: The METGastric randomized clinical trial. JAMA Oncol. 3:620–627. 2017. View Article : Google Scholar : PubMed/NCBI
8	Yoon HH, Bendell JC, Braiteh FS, Firdaus I, Philip PA, Cohn AL, Lewis N, Anderson DM, Arrowsmith E, Schwartz JD, et al: Ramucirumab combined with FOLFOX as front-line therapy for advanced esophageal, gastroesophageal junction, or gastric adenocarcinoma: A randomized, double-blind, multicenter Phase II trial. Ann Oncol. 27:2196–2203. 2016. View Article : Google Scholar : PubMed/NCBI
9	Kurokawa Y, Sugimoto N, Miwa H, Tsuda M, Nishina S, Okuda H, Imamura H, Gamoh M, Sakai D, Shimokawa T, et al: Phase II study of trastuzumab in combination with S-1 plus cisplatin in HER2-positive gastric cancer (HERBIS-1). Br J Cancer. 110:1163–1168. 2014. View Article : Google Scholar : PubMed/NCBI
10	Miura Y, Sukawa Y, Hironaka S, Mori M, Nishikawa K, Tokunaga S, Okuda H, Sakamoto T, Taku K, Nishikawa K, et al: Five-weekly S-1 plus cisplatin therapy combined with trastuzumab therapy in HER2-positive gastric cancer: A phase II trial and biomarker study (WJOG7212G). Gastric Cancer. 21:84–95. 2018. View Article : Google Scholar : PubMed/NCBI
11	Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, Sugimoto N, Lipatov O, Kim TY, et al; RAINBOW Study Group, . Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): A double-blind, randomised phase 3 trial. Lancet Oncol. 15:1224–1235. 2014. View Article : Google Scholar : PubMed/NCBI
12	Hironaka S, Ueda S, Yasui H, Nishina T, Tsuda M, Tsumura T, Sugimoto N, Shimodaira H, Tokunaga S, Moriwaki T, et al: Randomized, open-label, phase III study comparing irinotecan with paclitaxel in patients with advanced gastric cancer without severe peritoneal metastasis after failure of prior combination chemotherapy using fluoropyrimidine plus platinum: WJOG 4007 trial. J Clin Oncol. 31:4438–4444. 2013. View Article : Google Scholar : PubMed/NCBI
13	Kang YK, Boku N, Satoh T, Ryu MH, Chao Y, Kato K, Chung HC, Chen JS, Muro K, Kang WK, et al: Nivolumab in patients with advanced gastric or gastro-oesophageal junction cancer refractory to, or intolerant of, at least two previous chemotherapy regimens (ONO-4538-12, ATTRACTION-2): A randomised, double-blind, placebo-controlled, phase 3 trial. Lancet. 390:2461–2471. 2017. View Article : Google Scholar : PubMed/NCBI
14	American Society of Clinical Oncology: Outcomes of cancer treatment for technology assessment and cancer treatment guidelines. J Clin Oncol. 14:671–679. 1996. View Article : Google Scholar : PubMed/NCBI
15	Greer JA, Pirl WF, Jackson VA, Muzikansky A, Lennes IT, Heist RS, Gallagher ER and Temel JS: Effect of early palliative care on chemotherapy use and end-of-life care in patients with metastatic non-small-cell lung cancer. J Clin Oncol. 30:394–400. 2012. View Article : Google Scholar : PubMed/NCBI
16	Saito AM, Landrum MB, Neville BA, Ayanian JZ and Earle CC: The effect on survival of continuing chemotherapy to near death. BMC Palliat Care. 10:142011. View Article : Google Scholar : PubMed/NCBI
17	Kanda Y: Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 48:452–458. 2013. View Article : Google Scholar : PubMed/NCBI
18	Näppä U, Lindqvist O, Rasmussen BH and Axelsson B: Palliative chemotherapy during the last month of life. Ann Oncol. 22:2375–2380. 2011. View Article : Google Scholar : PubMed/NCBI
19	Lewin SN, Buttin BM, Powell MA, Gibb RK, Rader JS, Mutch DG and Herzog TJ: Resource utilization for ovarian cancer patients at the end of life: How much is too much? Gynecol Oncol. 99:261–266. 2005. View Article : Google Scholar : PubMed/NCBI
20	Temel JS, Greer JA, Muzikansky A, Gallagher ER, Admane S, Jackson VA, Dahlin CM, Blinderman CD, Jacobsen J, Pirl WF, et al: Early palliative care for patients with metastatic non-small-cell lung cancer. N Engl J Med. 363:733–742. 2010. View Article : Google Scholar : PubMed/NCBI
21	Bjordal K and Aass N: Palliative cytostatic treatment. Tidsskr Nor Laegeforen. 124:3206–3207. 2004.(In Norwegian). PubMed/NCBI
22	Hemminki K and Chen B: Familial risk for colorectal cancers are mainly due to heritable causes. Cancer Epidemiol Biomarkers Prev. 13:1253–1256. 2004.PubMed/NCBI
23	Kim A, Fall P and Wang D: Palliative care: Optimizing quality of life. J Am Osteopath Assoc. 105 Suppl 5:S9–S14. 2005.PubMed/NCBI
24	Keam B, Oh DY, Lee SH, Kim DW, Kim MR, Im SA, Kim TY, Bang YJ and Heo DS: Aggressiveness of cancer-care near the end-of-life in Korea. Jpn J Clin Oncol. 38:381–386. 2008. View Article : Google Scholar : PubMed/NCBI
25	Nakano K, Yoshida T, Furutama J and Sunada S: Quality of end-of-life care for patients with metastatic non-small-cell lung cancer in general wards and palliative care units in Japan. Support Care Cancer. 20:883–888. 2012. View Article : Google Scholar : PubMed/NCBI
26	Peppercorn JM, Smith TJ, Helft PR, Debono DJ, Berry SR, Wollins DS, Hayes DM, Von Roenn JH and Schnipper LE; American Society of Clinical Oncology, . American society of clinical oncology statement: Toward individualized care for patients with advanced cancer. J Clin Oncol. 29:755–760. 2011. View Article : Google Scholar : PubMed/NCBI
27	Ahsan H, Neugut AI, Garbowski GC, Jacobson JS, Forde KA, Treat MR and Waye JD: Family history of colorectal adenomatous polyps and increased risk for colorectal cancer. Ann Intern Med. 128:900–905. 1998. View Article : Google Scholar : PubMed/NCBI
28	Hashimoto K, Yonemori K, Katsumata N, Hotchi M, Kouno T, Shimizu C, Tamura K, Ando M, Takeuchi M and Fujiwara Y: Factors that affect the duration of the interval between the completion of palliative chemotherapy and death. Oncologist. 14:752–759. 2009. View Article : Google Scholar : PubMed/NCBI
29	Asola R, Huhtala H and Holli K: Intensity of diagnostic and treatment activities during the end of life of patients with advanced breast cancer. Breast Cancer Res Treat. 100:77–82. 2006. View Article : Google Scholar : PubMed/NCBI
30	Thorne SE, Bultz BD and Baile WF; SCRN Communication Team, . Is there a cost to poor communication in cancer care?: A critical review of the literature. Psychooncology. 14:875–884; discussion 885-886. 2005. View Article : Google Scholar : PubMed/NCBI
31	Miyamoto T, Ogawa M, Okagawa K, Ogawa Y, Fujimoto J, Kawasaki K, Mizunoya S, Fujiyama T, Kido Y, Shiozaki H, et al: The histological types of eary and simulating advanced gastric cancer, and their clinicopathological character -with special refemence to lymphnode metastasis and lymphatic invasion. Nihon Shokaki Geka Gakkai Zasshi. 16:1772–1777. 1983.(In Japanese).