Survival prolongation after treatment failure of first-line chemotherapy in patients with advanced gastric cancer: combined analysis of the Japan Clinical Oncology Group Trials JCOG9205 and JCOG9912
Survival prolongation after treatment failure of first-line chemotherapy in patients with advanced gastric cancer: combined analysis of the Japan Clinical Oncology Group Trials JCOG9205 and JCOG9912
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DOI：
10.1007/s10120-013-0309-z
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发表时间：
2014-07-01
期刊：
影响因子：
7.4
通讯作者：
Ohtsu, Atsushi
中科院分区：
文献类型：
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作者：
Takashima, Atsuo;Boku, Narikazu;Ohtsu, Atsushi
由日本临床肿瘤组进行的两项晚期胃癌一线化疗的随机III期试验（JCOG 9205和JCOG 9912）使用5-氟尿嘧啶连续输注（5-FUci）作为对照组。S-1、伊立替康和紫杉烷类）在20世纪90年代末JCOG 9205之后被引入作为二线化疗。该联合分析评估了JCOG 9912的5-FUci组中的患者在校正基线因素后是否表现出更好的生存率，并调查了生存期延长的原因。受试者是分配到5-FUci组的符合JCOG 9205和JCOG 9912合格标准的患者。采用考克斯比例风险模型校正基线特征后，比较总生存期（OS）、至治疗失败时间（TTF）和一线化疗治疗失败后生存期（OS-TTF）。二线化疗的细节也进行了审查。联合分析包括89和230例患者在JCOG 9205和JCOG 9912，分别。调整基线特征后，两组之间的TTF相似（HR 0.95; 95% CI，0.73-1.26）。然而，在JCOG 9912中，OS（HR，0.74; 95% CI，0.56-0.99）和OS-TTF（HR，0.76; 95% CI，0.57-1.01）均较长。与JCOG 9205相比，JCOG 9912中接受二线化疗（83 vs. 52%）和新药（77 vs. 10%）的患者更多。接受二线化疗的患者的OS-TTF显著延长（HR，0.66; 95% CI，0.46-0.95）JCOG 9912的OS和OS-TTF长于JCOG 9205。使用新药的二线化疗是观察到的生存期延长的潜在原因。
Two randomized phase III trials of first-line chemotherapy for advanced gastric cancer (JCOG9205 and JCOG9912) conducted by the Japan Clinical Oncology Group used 5-fluorouracil continuous infusion (5-FUci) as the control arm. New active agents (e.g., S-1, irinotecan, and taxanes) were introduced as second-line chemotherapy in the late 1990s after JCOG9205. This combined analysis evaluated whether patients in the 5-FUci arm of JCOG9912 exhibited better survival after adjusting for baseline factors and also investigated the cause of survival prolongation.The subjects were patients assigned to the 5-FUci arms who met the eligibility criteria of both JCOG9205 and JCOG9912. Overall survival (OS), time to treatment failure (TTF), and survival after treatment failure in the first-line chemotherapy (OS-TTF) were compared after adjusting baseline characteristics using the Cox proportional hazard model. Second-line chemotherapy details were also reviewed.The combined analysis included 89 and 230 patients in JCOG9205 and JCOG9912, respectively. After adjusting baseline characteristics, TTF was similar between groups (HR 0.95; 95 % CI, 0.73-1.26). However, both OS (HR, 0.74; 95 % CI, 0.56-0.99) and OS-TTF (HR, 0.76; 95 % CI, 0.57-1.01) were longer in JCOG9912. More patients in JCOG9912 received second-line chemotherapy (83 vs. 52 %) with new drugs (77 vs. 10 %) than in JCOG9205. OS-TTF was substantially prolonged in patients who received second-line chemotherapy (HR, 0.66; 95 % CI, 0.46-0.95).OS and OS-TTF were longer in JCOG9912 than JCOG9205. Second-line chemotherapy with new drugs is a potential reason for the observed prolongation of survival.