Systemic Treatment Strategies and Outcomes of Patients With Synchronous Peritoneal Metastases of Gastric Origin: A Nationwide Population-Based Study
Search for other papers by Niels A.D. Guchelaar in
Current site
Google Scholar
PubMed
Search for other papers by Bo J. Noordman in
Current site
Google Scholar
PubMed
Search for other papers by Marion W. Welten in
Current site
Google Scholar
PubMed
Search for other papers by Myron T. van Santen in
Current site
Google Scholar
PubMed
Search for other papers by Micha J. de Neijs in
Current site
Google Scholar
PubMed
Department of Pharmacy, Erasmus Medical Center, Rotterdam, the Netherlands
Search for other papers by Stijn L.W. Koolen in
Current site
Google Scholar
PubMed
Cancer Center Amsterdam, Cancer Treatment and Quality of Life, Amsterdam, the Netherlands
Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Search for other papers by Rob H.A. Verhoeven in
Current site
Google Scholar
PubMed
Search for other papers by Esther Oomen-de Hoop in
Current site
Google Scholar
PubMed
Search for other papers by Pieter C. van der Sluis in
Current site
Google Scholar
PubMed
Search for other papers by Sjoerd M. Lagarde in
Current site
Google Scholar
PubMed
Department of Medical Oncology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Search for other papers by Hanneke W.M. van Laarhoven in
Current site
Google Scholar
PubMed
Department of Epidemiology, GROW-School for Oncology and Developmental Biology, Maastricht University, Maastricht, the Netherlands
Search for other papers by Ignace H.J.T. de Hingh in
Current site
Google Scholar
PubMed
Search for other papers by Geert-Jan Creemers in
Current site
Google Scholar
PubMed
Search for other papers by Bianca Mostert in
Current site
Google Scholar
PubMed
Search for other papers by Bas P.L. Wijnhoven in
Current site
Google Scholar
PubMed
Search for other papers by Ron H.J. Mathijssen in
Current site
Google Scholar
PubMed
Background: Palliative systemic treatment is currently standard of care for metastatic gastric cancer. However, patients with peritoneal metastases of gastric origin are often underrepresented in clinical studies due to unmeasurable radiologic disease. This study describes the systemic treatment strategies and outcomes in patients with peritoneal metastases in a nationwide real-world setting. Methods: Patients with gastric adenocarcinoma and synchronous peritoneal metastases (with or without other metastases) diagnosed in the Netherlands between 2015 and 2020 were identified from the nationwide Netherlands Cancer Registry. Median overall survival (OS) and time-to-treatment failure were determined and multivariable Cox regression analyses were used to compare treatment groups, corrected for relevant tumor and patient characteristics. Results: In total, 1,972 patients were included, of whom 842 (43%) were treated with palliative systemic therapy. The majority received capecitabine + oxaliplatin (CAPOX; 44%), followed by fluorouracil/leucovorin/oxaliplatin (FOLFOX; 19%), and epirubicin + capecitabine + oxaliplatin (EOX; 8%). Of the 99 (45%) patients who received second-line systemic treatment, ramucirumab + paclitaxel were administered most frequently (63%). After adjustment for sex, age, comorbidities, performance status, tumor location, Lauren classification, and the presence of metastases outside of the peritoneum, patients treated with a triplet containing docetaxel and those treated with a regimen containing trastuzumab had a significantly longer OS compared with patients treated with a doublet containing a fluoropyrimidine derivate + oxaliplatin (hazard ratio [HR], 0.69; 95% CI, 0.52–0.91, and HR, 0.68; 95% CI, 0.51–0.91, respectively). Monotherapy was associated with a shorter OS (HR, 2.08, 95% CI, 1.53–2.83). Conclusions: There is substantial heterogeneity in systemic treatment choices in patients with gastric cancer and peritoneal metastases in the Netherlands. In this study, patients treated with triplets containing docetaxel and with trastuzumab-containing regimens survived longer than patients who received doublet therapy. Despite this, median OS for all treatment groups remained below one year.
Submitted October 16, 2023; final revision received January 11, 2024; accepted for publication January 23, 2024. Published online July 29, 2024.
Previous presentation: The results of this study were presented at ESMO Congress 2023; October 20–24, 2023; Madrid, Spain. Abstract 1589P.
Author contributions: Conceptualization: Guchelaar, Noordman, Koolen, Mostert, Wijnhoven, Mathijssen. Data curation: Guchelaar, Noordman, van Santen, de Neijs, Verhoeven. Formal analysis: Guchelaar, Noordman. Methodology: Guchelaar, Noordman, van Santen, de Neijs, Verhoeven, Oomen-de Hoop, Mostert, Mathijssen. Writing—original draft: Guchelaar, Noordman. Writing—review & editing: All authors.
Data availability statement: Data can be made available by the Netherlands Comprehensive Cancer Organization on justified request.
Disclosures: Dr. Verhoeven has disclosed serving as a principal investigator for Bristol Myers Squibb. Dr. van Laarhoven has disclosed receiving grant/research support from Auristone, Incyte, Merck & Co., Inc., ORCA Therapeutics, and Servier; serving as a scientific advisor for Amphera, Anocca, Astellas Pharma, AstraZeneca, BeiGene, Boehringer Ingelheim, Daiichi-Sankyo, Dragonfly Therapeutics, Inc., Merck & Co., Inc., Myeloid Therapeutics, and Servier; and serving on the speaker’s bureau for Astellas Pharma, BeiGene, Bristol Myers Squibb, Daiichi-Sankyo, and Novartis. Dr. Mostert has disclosed serving as a consultant for Bristol Myers Squibb, Lilly, and Servier; and receiving grant/research support from Bristol Myers Squibb, Sanofi, and Pfizer Inc. The remaining authors have disclosed that they have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.
Supplementary material: Supplementary material associated with this article is available online at https://doi.org/10.6004/jnccn.2024.7013. The supplementary material has been supplied by the author(s) and appears in its originally submitted form. It has not been edited or vetted by JNCCN. All contents and opinions are solely those of the author. Any comments or questions related to the supplementary materials should be directed to the corresponding author.
Supplementary Materials
- Supplemental Materials (PDF 714 KB)
© 2019-2024 National Comprehensive Cancer Network