More than half of cases of gastric cancer (GC) are diagnosed in elderly patients (≥70 years). While doublet combination with fluoropyrimidines and platinum is currently considered standard first-line chemotherapy in advanced GC, the main goal of chemotherapy remains palliation.
Materials and Methods
In a multi-center phase III trial, patients with chemotherapy-naïve, metastatic GC, aged 70 years or older were randomized 1:1 to receive X monotherapy (capecitabine 1000 mg/m2 bid po on days one to fourteen) or XELOX (X plus oxaliplatin 110 mg/m2 iv on D1). Treatment was repeated every 21 days until disease progression, unacceptable toxicity, or withdrawal. Primary endpoint was overall survival (OS).
In total, 50 patients with a median age of 77 (range, 70 to 84) were enrolled (X, n = 26; XELOX, n = 24). No treatment-related serious adverse events or unexpected toxicities were observed. The most frequently observed toxicities were nausea and hand-foot syndrome, with fatigue and peripheral neuropathy more common in XELOX than in X patients. Median OS was 11.1 months for XELOX arm and 6.3 months for X arm (HR 0.58, 95% CI 0.30–1.12, P = 0.108). Although the difference was not significant, on the basis of evidence of superiority of XELOX seen in the first interim analysis, an independent data monitoring committee recommended early stopping of the trial. PFS was significantly longer (HR 0.32, 95% CI 0.17–0.61, P < 0.001) with XELOX (7.1 months) than with X (2.6 months).
Platinum-based combination chemotherapy was associated with survival benefit, as compared with X monotherapy in elderly patients with GC.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Journal of Geriatric Oncology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data.J Clin Oncol. 2006; 24: 2903-2909
- Disparities in gastric cancer chemotherapy between the East and West.J Clin Oncol. 2006; 24: 2188-2196
- Chemotherapy of lung cancer in the elderly.Crit Rev Oncol Hematol. 2002; 41: 349-361
- Older age–not a barrier to cancer treatment.N Engl J Med. 2001; 345: 1127-1128
- Gastric cancer epidemiology in Korea.J Gastric Cancer. 2011; 11: 135-140
- Retrospective analyses of cisplatin-based doublet combination chemotherapy in patients with advanced gastric cancer.BMC Cancer. 2010; 10: 583
- S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial.Lancet Oncol. 2008; 9: 215-221
- A randomised multicentre phase II trial of capecitabine vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer.Br J Cancer. 2008; 99: 584-590
- A new method of classifying prognostic comorbidity in longitudinal studies: development and validation.J Chronic Dis. 1987; 40: 373-383
- The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology.J Natl Cancer Inst. 1993; 85: 365-376
- Validation of the Korean version of the EORTC QLQ-C30.Qual Life Res. 2004; 13: 863-868
- Impact of age on clinicopathological features and survival of patients with noncardia gastric adenocarcinoma.J Gastric Cancer. 2014; 14: 238-245
- Underrepresentation of patients 65 years of age or older in cancer-treatment trials.N Engl J Med. 1999; 341: 2061-2067
- Predicting chemotherapy toxicity in older adults with cancer: a prospective multicenter study.J Clin Oncol. 2011; 29: 3457-3465
- Comorbidity and age as predictors of risk for early mortality of male and female colon carcinoma patients: a population-based study.Cancer. 1998; 82: 2123-2134
- Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial.Ann Oncol. 2009; 20: 666-673
- Capecitabine and oxaliplatin for advanced esophagogastric cancer.N Engl J Med. 2008; 358: 36-46
- Participation of patients 65 years of age or older in cancer clinical trials.J Clin Oncol. 2003; 21: 1383-1389
- Carboplatin and weekly paclitaxel doublet chemotherapy compared with monotherapy in elderly patients with advanced non-small-cell lung cancer: IFCT-0501 randomised, phase 3 trial.Lancet. 2011; 378: 1079-1088
Published online: January 23, 2017
Accepted: January 13, 2017
Received in revised form: November 15, 2016
Received: October 9, 2016
© 2017 Elsevier Ltd. All rights reserved.