Einfluss einer Zweitlinien-Salvage-Therapie auf die Prognose von Patienten mit metastasiertem Magenkarzinom : Ergebnisse einer Analyse aus einer Schwerpunktklinik für internistische Onkologie
Introduction: Driven by studies in Asian Countries, 2nd line CT was established recently in advanced GC. This analysis was performed to investigate the role of 2nd line chemotherapy in unselected patients (pts) of daily praxis in a hospital department dedicated to gastrointestinal oncology. Methods: 376 pts from the data source of the hospital were screened from 1999 to 2012 and 92 pts fulfilled the inclusion criteria of this retrospective analysis. Results: Characteristics of pts: median age 62y, m/f 54/38, synchrone metastases 59%, 1st line CT including platin derivatives 78%. The interval between end of 1st line and start of 2nd line CT was short with a duration of less than 3 months in 68% of the pts. Median duration of 2nd line CT was 8 weeks. 35 and 57 pts received mono- or combination CT, respectively, 17 of 57 (30%) including platin compounds. The rates of severe toxicity (grade > 2) were low (maximum 10% each for diarrhea and nausea/vomiting), but 35% of the pts had at least one episode of hospitalization due to toxic side effects. At time of evaluation 82/92 pts (89%) had died. Median overall survival (OS) from start of 2nd line CT reached 7.3 months (mo) and 27% of pts survived 1 year. The calculated OS since start of 1st line CT was 14.4 mo. Progression free survival (PFS) was 2.9 mo. There was no difference in OS and PFS for pts > 70y and younger ones. Peritoneal carcinomatosis (p<0.01) was a negative prognostic factor for OS (4.6 versus 9.8 mo) as was treatment free interval of less than 3 mo (p=0.02) and 2nd line CT without platin for PFS. Conclusions: Our results confirm the value of 2nd line CT in the era before including molecular directed drugs. The survival data in unselected pts treated in daily praxis at an experienced centre are comparable to those of multicentric randomized studies. Peritoneal carcinomatosis and short treatment free interval after 1st line CT may preclude pts from starting 2nd line CT. The role of platin combinations should be evaluated in 2nd line CT.