Publication:

Are taxane based regimens better than non-taxane fluoropyrimidine based regimens in advanced gastric cancer? Findings from an observational multicentre study, South India

Background Capecitabine, 5 Fluorouracil, platinum agents and taxanes are either used alone or in combination in advanced gastric cancers (AGC). Data on tolerability and efficacy of these regimens are minimal. We aimed to report proportion of AGC patients opting for best supportive care upfront and tolerability and efficacy of taxane and non-taxane fluoropyrimidine based regimens from three oncology centers, South India.

Methods Case records of AGC patients initiated on either taxane or non-taxane fluoropyrimidine based chemotherapy during May 2016 to Dec 2017 in three private tertiary cancer care centers across two states in south India were reviewed. Information on clinical characteristics, regimen used, radiological and clinical response, toxicity and its related hospital admissions were extracted. Statistical analysis was done by categorical variables that were summarized using proportions. Median survival was calculated using Kaplan Meier curves and comparison between the groups were done using log-rank test.

Results Of 88 AGC patients, 27 patients (30.7%) opted for best supportive care; 19 and 41 patients received paclitaxel based and non-taxane fluoropyrimidine based regimens respectively. There was no statistically significant difference in pain symptoms, vomiting, hospital admissions and intensive care admissions between the two regimens. Median (inter quartile range) survival of patients receiving best supportive care, taxane based regimen and non-taxane fluoropyrimidine regimen were 3.1 (1.5-16.1), 7.4 (1.6-15.0) and 11.6 (3.2-29.3) months respectively. Median (range) survival on any chemotherapy was 10.3 (1.6-29.3) months and it was significantly higher compared to best supportive care (p<0.001)

Conclusions AGC patients on chemotherapy had improved overall survival compared to stand alone best supportive care. Fluoropyrimidine based regimens offered better survival than taxane based regimen.