1. Optimal treatment strategy after first-line induction therapy in advanced HER2-positive oeso-gastric adenocarcinoma—a retrospective, international, multicentric AGEO study.
- Author
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Bergen, Elisabeth S., Pilla, Lorenzo, Auclin, Edouard, Ilhan-Mutlu, Aysegül, Prager, Gerald W., Pietrantonio, Filippo, Antista, Maria, Ghelardi, Filippo, Basile, Debora, Aprile, Giuseppe, Longarini, Raffaella, Hautefeuille, Vincent, Tougeron, David, Artru, Pascal, Mabro, May, Drouillard, Antoine, Roth, Gael, Ben Abdelghani, Meher, Clement, Inès, and Toullec, Clemence
- Subjects
INDUCTION chemotherapy ,ADENOCARCINOMA ,PROGRESSION-free survival ,MULTIVARIATE analysis ,TRASTUZUMAB - Abstract
Background: The optimal treatment strategy after first-line induction therapy in advanced HER2-positive oeso-gastric adenocarcinoma (OGA) remains challenging. Methods: Patients treated with trastuzumab (T) plus platinum salts and fluoropyrimidine (F) as first-line chemotherapy between 2010 and 2020 for HER2-positive advanced OGA at 17 academic care centers in France, Italy, and Austria were included. The primary objective was the comparison of F + T vs T alone as maintenance regimen in terms of progression-free survival (PFS) and overall survival (OS) after a platinum-based chemotherapy induction + T. As secondary objective, PFS and OS between patients treated with reintroduction of initial chemotherapy or standard second-line chemotherapy at progression were assessed. Results: Among the 157 patients included, 86 (55%) received F + T and 71 (45%) T alone as a maintenance regimen after a median of 4 months of induction chemotherapy. Median PFS from start of maintenance therapy was 5.1 months in both groups (95% CI 4.2–7.7 for F + T and 95% CI 3.7–7.5 for T alone; p = 0.60) and median OS was 15.2 (95% CI 10.9–19.1) and 17.0 months (95% CI 15.5–21.6) for F + T and T alone, respectively (p = 0.40). Of 112/157 patients (71%) receiving systemic therapy after progression under maintenance, 26/112 (23%) were treated with a reintroduction of initial chemotherapy + T and 86/112 (77%) with a standard second-line regimen. Here, median OS was significantly longer with the reintroduction (13.8 (95% CI 12.1–19.9) vs 9.0 months (95% CI 7.1–11.9); p = 0.007) as confirmed by multivariate analysis (HR 0.49; 95% CI 0.28–0.85; p = 0.01). Conclusion: No additional benefit of adding F to T monotherapy as a maintenance treatment could be observed. Reintroduction of initial therapy at first progression may be a feasible approach to preserve later treatment lines. [ABSTRACT FROM AUTHOR]
- Published
- 2023
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