Second-line Chemotherapy in Advanced Gastric Cancer: Taxanes versus 5-FU-Based Treatment.

Objective: To determine the comparative efficacy of taxane-based treatment and 5-FU-based treatment as second-line chemotherapy regimens in advanced gastric cancer patients, as measured by overall survival (OS) and progression-free survival (PFS).

Study design: Observational study. Place and Duration of the Study: Department of Medical Oncology, Health Science University Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkiye, from January 2008 and December 2020.

Methodology: Patients aged 18 years and older, diagnosed with gastric cancer, who received at least one line chemotherapy were included. Patients who received FOLFIRI, FOLFOX, and capecitabine in the second-line therapy were grouped as those who received 5-FU-based treatment, while those who received docetaxel and paclitaxel were grouped as those who received taxan-based treatment. The primary outcome measures, OS and PFS, were assessed and compared between the treatment groups using the Kaplan-Meier method.

Results: A total of 172 patients were included in this analysis, among whom 73 (42.4%) received second-line chemotherapy. Among the patients who received the second-line treatment, 50 (68.5%) were males. The median age of the cohort was 60 years (23-86), with 37 (50.7%) patients falling into the <60 age group. The overall response rates (ORR) were 8% (2/25) in the taxane group and 16.7% (8/48) in the 5-FU-based treatment group. The median overall survival (OS) for all patients receiving second-line therapy was 7.52 months (standard error: 0.97; 95% confidence interval [CI]: 5.62-9.43). Specifically, the median OS was 5.16 months (standard error: 1.07; 95% CI: 3.07-7.25) in the taxane group and 8.02 months (standard error: 1.40; 95% CI: 5.28-10.75) in the group receiving 5-FU-based therapy (p=0.11).

Conclusion: The superiority of chemotherapy regimens to each other could not be demonstrated. However, the second-line treatment demonstrated clear superiority over the best supportive care. Therefore, it is recommended that all patients with good performance status (PS) should be offered second-line treatment.

Key words: Gastric cancer, Second-line chemotherapy, Taxanes, Treatment efficacy, 5-Fluorouracil.