Skip to main navigation menu Skip to main content Skip to site footer

Original article

Vol. 141 No. 3334 (2011)

Survival predictors for second-line chemotherapy in Caucasian patients with metastatic gastric cancer

  • P Bohanes
  • P Morel
  • O Huber
  • DS Courvoisier
  • TV Perneger
  • AD Roth
Cite this as:
Swiss Med Wkly. 2011;141:w13249


PRINCIPLES: There are very limited data suggesting a benefit for second-line chemotherapy in advanced gastric cancer. Therefore, the number of patients who receive further treatment after failure of first-line chemotherapy varies considerably, ranging from 14% to 75%. In the absence of a demonstrated survival benefit of second-line chemotherapy, appropriate selection of patients based on survival predictors is essential. However, no clinico-pathologic parameters are currently widely adopted in clinical practice. We looked exclusively at Caucasian patients with metastatic gastric cancer treated with second-line chemotherapy to see if we could establish prognostic factors for survival.

METHODS: This study retrospectively evaluated 43 Caucasian patients with metastatic gastric cancer treated with second-line chemotherapy at the Geneva University Hospital. Prognostic values of clinico-pathologic parameters were analysed by Cox regression for overall survival (OS).

RESULTS:Univariate analysis found three variables to be associated with survival: progression-free survival (PFS) at first-line chemotherapy of more than 26 weeks (hazard ratio (HR) = 0.33, confidence interval (CI) 95% 0.16–0.65, p = 0.002), previous curative surgery (HR = 0.51, CI 95% 0.27–0.96, p = 0.04) and carcinoma embryonic antigen (CEA) >6.5 μg/l (HR = 1.97, CI 95% 1.06–3.65, p = 0.03).

CONCLUSIONS: In line with published data, sensitivity to previous chemotherapy identifies Caucasian patients who will survive the longest following second-line chemotherapy. A low tumour burden and previous curative gastrectomy also seem to have a positive prognostic value.


  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. Int J Cancer. 2010;127(12):2893–917.
  2. Wu WK, Lee CW, Cho CH, Fan D, Wu K, Yu J, et al. MicroRNA dysregulation in gastric cancer: a new player enters the game. Oncogene. 2010;29(43):5761–71.
  3. Jenal M, Britschgi C, Fey MF, Tschan MP. Inactivation of the hypermethylated in cancer 1 tumour suppressor--not just a question of promoter hypermethylation? Swiss Med Wkly. 2010;140:w13106.
  4. Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK, et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol. 1997;15(1):261–7.
  5. Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V325 study group. J Clin Oncol. 2006;24(31):4991–7.
  6. Cunningham D, Starling N, Rao S, Iveson T, Nicolson M, Coxon F, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008;358(1):36–46.
  7. Cunningham D, Allum WH, Stenning SP, Thompson JN, Van de Velde CJ, Nicolson M, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355(1):11–20.
  8. Thuss-Patience PC, Kretzschmar A, Deist T, Hinke A, Bichev D, Lebedinzew B, et al. Irinotecan versus best supportive care (BSC) as second-line therapy in gastric cancer: A randomized phase III study of the arbeitsgemeinschaft internistische onkologie (AIO). J Clin Oncol. 2009;27:15s, (suppl; abstr 4540).
  9. Lauren P. The two histological main types of gastric carcinoma: Diffuse and so-called intestinal-type carcinoma. An attempt at a histo-clinical classification. Acta Pathol Microbiol Scand. 1965;64:31–49.
  10. Catalano V, Graziano F, Santini D, D’Emidio S, Baldelli AM, Rossi D, et al. Second-Line chemotherapy for patients with advanced gastric cancer: Who may benefit? Br J Cancer. 2008;99(9):1402–7.
  11. Stahl M, Müller C, Köster W, Wilke H. Second-Line chemotherapy of advanced disseminated gastric cancer after cisplatin, infusional 5-fluorouracil, folinic acid (PLF): Benefit dependent on progression-free interval after first-line therapy. Onkologie. 2005;28(10):499–502.
  12. Hashimoto K, Takashima A, Nagashima K, Okazaki SS, Nakajima TE, Kato K, et al. Progression-Free survival in first-line chemotherapy is a prognostic factor in second-line chemotherapy in patients with advanced gastric cancer. J Cancer Res Clin Oncol. 2010;36(7):1059–64.
  13. Ji SH, Lim do H, Yi SY, Kim HS, Jun HJ, Kim KH, et al. A retrospective analysis of second-line chemotherapy in patients with advanced gastric cancer. BMC Cancer. 2009;9:110.
  14. Kanagavel D, Pokataev IA, Fedyanin MY, Tryakin AA, Bazin IS, Narimanov MN, et al. A prognostic model in patients treated for metastatic gastric cancer with second-line chemotherapy. Ann Oncol. 2010;21(9):1779–85.
  15. Lee J, Lim T, Uhm JE, Park KW, Park SH, Lee SC, et al. Prognostic model to predict survival following first-line chemotherapy in patients with metastatic gastric adenocarcinoma. Ann Oncol. 2007;18(5):886–91.
  16. Jo JC, Lee JL, Ryu MH, Sym SJ, Lee SS, Chang HM, et al. Docetaxel monotherapy as a second-line treatment after failure of fluoropyrimidine and platinum in advanced gastric cancer: Experience of 154 patients with prognostic factor analysis. Jpn J Clin Oncol. 2007;37(12):936–41.
  17. Matsuda G, Kunisaki C, Makino H, Fukahori M, Kimura J, Sato T, et al. Phase II study of weekly paclitaxel as a second-line treatment for s-1-refractory advanced gastric cancer. Anticancer Res. 2009;29(7):2863–7.
  18. Kodera Y, Ito S, Mochizuki Y, Fujitake S, Koshikawa K, Kanyama Y, et al. A phase II study of weekly paclitaxel as second-line chemotherapy for advanced gastric cancer (CCOG0302 study). Anticancer Res. 2007;27(4C):2667–71.
  19. Koizumi W, Akiya T, Sato A, Yamaguchi K, Sakuyama T, Nakayama N, et al. Second-Line chemotherapy with biweekly paclitaxel after failure of fluoropyrimidine-based treatment in patients with advanced or recurrent gastric cancer: A report from the gastrointestinal oncology group of the tokyo cooperative oncology group, TCOG GC-0501 trial. Jpn J Clin Oncol. 2009;39(11):713–9.
  20. Baize N, Abakar-Mahamat A, Mounier N, Berthier F, Caroli-Bosc FX. Phase II study of paclitaxel combined with capecitabine as second-line treatment for advanced gastric carcinoma after failure of cisplatin-based regimens. Cancer Chemother Pharmacol. 2009;64(3):549–55.
  21. Rosati G, Bilancia D, Germano D, Dinota A, Romano R, Reggiardo G, et al. Reduced dose intensity of docetaxel plus capecitabine as second-line palliative chemotherapy in patients with metastatic gastric cancer: A phase II study. Ann Oncol 2007;18(Suppl 6):vi128–32.
  22. Kunisaki C, Imada T, Yamada R, Hatori S, Ono H, Otsuka Y, et al. Phase II study of docetaxel plus cisplatin as a second-line combined therapy in patients with advanced gastric carcinoma. Anticancer Res. 2005;25(4):2973–7.
  23. Polyzos A, Tsavaris N, Kosmas C, Polyzos K, Giannopoulos A, Felekouras E, et al. Subsets of patients with advanced gastric cancer responding to second-line chemotherapy with docetaxel-cisplatin. Anticancer Res. 2006;26(5B):3749–53.
  24. Barone C, Basso M, Schinzari G, Pozzo C, Trigila N, D’Argento E, et al. Docetaxel and oxaliplatin combination in second-line treatment of patients with advanced gastric cancer. Gastric Cancer. 2007;10(2):104–11.
  25. Kim ST, Kang WK, Kang JH, Park KW, Lee J, Lee SH, et al. Salvage chemotherapy with irinotecan, 5-fluorouracil and leucovorin for taxane- and cisplatin-refractory, metastatic gastric cancer. Br J Cancer. 2005;92(10):1850–4.
  26. Seo MD, Lee KW, Lim JH, Yi HG, Kim DY, Oh DY, et al. Irinotecan combined with 5-fluorouracil and leucovorin as second-line chemotherapy for metastatic or relapsed gastric cancer. Jpn J Clin Oncol. 2008;38(9):589–95.
  27. Sun Q, Hang M, Xu W, Mao W, Hang X, Li M, Zhang J. Irinotecan plus capecitabine as a second-line treatment after failure of 5-fluorouracil and platinum in patients with advanced gastric cancer. Jpn J Clin Oncol. 2009;39(12):791–6.
  28. Giuliani F, Molica S, Maiello E, Battaglia C, Gebbia V, Di Bisceglie M, et al. Irinotecan (CPT-11) and mitomycin-c (MMC) as second-line therapy in advanced gastric cancer: A phase II study of the gruppo oncologico dell' italia meridionale (prot. 2106). Am J Clin Oncol. 2005;28(6):581–5.