Cancer Res Treat.  2019 Jan;51(1):223-239. 10.4143/crt.2018.073.

Treatment Patterns and Changes in Quality of Life during First-Line Palliative Chemotherapy in Korean Patients with Advanced Gastric Cancer

• Kim JW
• Kim JG
• Kang BW
• Chung IJ
• Hong YS
• Kim TY
• Song HS
• Lee KH
• Zang DY
• Ko YH
• Song EK
• Baek JH
• Koo D
• Oh SY
• Cho H
• Lee KW

• KMID: 2437615
• DOI: http://doi.org/10.4143/crt.2018.073

Abstract

PURPOSE
The purpose of this study was to evaluate chemotherapy patterns and changes in quality of life (QOL) during first-line palliative chemotherapy for Korean patients with unresectable or metastatic/recurrent gastric cancer (GC).
MATERIALS AND METHODS
Thiswas a non-interventional, multi-center, prospective, observational study of 527 patients in Korea. QOL assessments were conducted using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-STO22 every 3 months over a 12-month period during first-line palliative chemotherapy. The specific chemotherapy regimens were selected by individual clinicians.
RESULTS
Most patients (93.2%) received combination chemotherapy (mainly fluoropyrimidine plus platinum) as their first-line palliative chemotherapy. The median progression-free survival and overall survival were 8.2 and 14.8 months, respectively. Overall, "a little" changes (differences of 5-10 points from baseline)were observed in some of the functioning or symptom scales; none of the QOL scales showed either "moderate" or "very much" change (i.e., ≥ 11 point difference from baseline). When examining the best change in each QOL domain from baseline, scales related to some aspects of functioning, global health status/QOL, and most symptoms revealed significant improvements (p < 0.05). Throughout the course of first-line palliative chemotherapy, most patients' QOL was maintained to a similar degree, regardless of their actual response to chemotherapy.
CONCLUSION
This observational study provides important information on the chemotherapy patterns and QOL changes in Korean patientswith advanced GC. Overall, first-line palliative chemotherapy was found to maintain QOL, and most parameters showed an improvement compared with the baseline at some point during the course.

Keyword

Advanced gastric cancer; First-line palliative chemotherapy; Quality of life

MeSH Terms

Disease-Free Survival
Drug Therapy*
Drug Therapy, Combination
Global Health
Humans
Korea
Observational Study
Prospective Studies
Quality of Life*
Stomach Neoplasms*
Weights and Measures

Figure

• 

  Fig. 1. Study flow chart.

• 

  Fig. 2. Overall (A) and progression-free survival (B) of first-line palliative chemotherapy. CI, confidence interval.

• 

  Fig. 3. Comparison of overall (A) and progression-free survival (B) of first-line palliative chemotherapy between patients aged < 70 and ≥ 70 years. CI, confidence interval.

• 

  Fig. 4. Changes in quality of life domains during first-line palliative chemotherapy. QLQ, Quality of Life Questionnaires; QOL, quality of life.

Reference

References

1. Ferlay J, Soerjomataram I, Dikshit R, Eser S, Mathers C, Rebelo M, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136:E359–86.

2. Jung KW, Won YJ, Oh CM, Kong HJ, Lee DH, Lee KH, et al. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2014. Cancer Res Treat. 2017; 49:292–305.

3. Digklia A, Wagner AD. Advanced gastric cancer: current treatment landscape and future perspectives. World J Gastroenterol. 2016; 22:2403–14.

4. Glimelius B, Ekstrom K, Hoffman K, Graf W, Sjoden PO, Haglund U, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol. 1997; 8:163–8.

5. Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer. 1995; 71:587–91.

6. Pavlakis N, Sjoquist KM, Martin AJ, Tsobanis E, Yip S, Kang YK, et al. Regorafenib for the Treatment of Advanced Gastric Cancer (INTEGRATE): a multinational placebo-controlled phase II trial. J Clin Oncol. 2016; 34:2728–35.

7. Wilke H, Muro K, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, et al. Ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated advanced gastric or gastro-oesophageal junction adenocarcinoma (RAINBOW): a double-blind, randomised phase 3 trial. Lancet Oncol. 2014; 15:1224–35.

8. Nieder C, Norum J. Early palliative care in patients with metastatic non-small cell lung cancer. Ann Palliat Med. 2012; 1:84–6.

9. Lee JH, Kim JG, Jung HK, Kim JH, Jeong WK, Jeon TJ, et al. Clinical practice guidelines for gastric cancer in Korea: an evidence-based approach. J Gastric Cancer. 2014; 14:87–104.

10. Bang YJ, Yalcin S, Roth A, Hitier S, Ter-Ovanesov M, Wu CW, et al. Registry of gastric cancer treatment evaluation (REGATE): I baseline disease characteristics. Asia Pac J Clin Oncol. 2014; 10:38–52.

11. Ter-Ovanesov M, Yalcin S, Zalcberg J, Hitier S, Bang YJ, Wu CW, et al. Registry of gastric cancer treatment evaluation (REGATE): II treatment practice. Asia Pac J Clin Oncol. 2013; 9:373–80.

12. Blazeby JM, Conroy T, Bottomley A, Vickery C, Arraras J, Sezer O, et al. Clinical and psychometric validation of a questionnaire module, the EORTC QLQ-STO 22, to assess quality of life in patients with gastric cancer. Eur J Cancer. 2004; 40:2260–8.

13. Aaronson NK, Ahmedzai S, Bergman B, Bullinger M, Cull A, Duez NJ, et al. 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; 85:365–76.

14. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2009; 45:228–47.

15. Osoba D, Rodrigues G, Myles J, Zee B, Pater J. Interpreting the significance of changes in health-related quality-of-life scores. J Clin Oncol. 1998; 16:139–44.

16. Davidson M, Okines AF, Starling N. Current and future therapies for advanced gastric cancer. Clin Colorectal Cancer. 2015; 14:239–50.

17. Carter GC, Kaltenboeck A, Ivanova J, Liepa AM, San Roman A, Koh M, et al. Real-world treatment patterns among patients with advanced gastric cancer in South Korea. Cancer Res Treat. 2017; 49:578–87.

18. Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol. 2006; 24:2903–9.

19. Van Cutsem E, Moiseyenko VM, Tjulandin S, Majlis A, Constenla M, Boni C, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006; 24:4991–7.

20. Wagner AD, Syn NL, Moehler M, Grothe W, Yong WP, Tai BC, et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev. 2017; 8:CD004064.

21. Cho YH, Kim SY, Lee MH, Yoo MW, Bang HY, Lee KY, et al. Comparative analysis of the efficacy and safety of chemotherapy with oxaliplatin plus fluorouracil/leucovorin between elderly patients over 65 years and younger patients with advanced gastric cancer. Gastric Cancer. 2012; 15:389–95.

22. Kim YS, Hong J, Sym SJ, Park SH, Park J, Cho EK, et al. Oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX-4) combination chemotherapy as a salvage treatment in advanced gastric cancer. Cancer Res Treat. 2010; 42:24–9.

23. Kang JH, Lee SI, Lim DH, Park KW, Oh SY, Kwon HC, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol. 2012; 30:1513–8.

24. Kim HS, Kim HJ, Kim SY, Kim TY, Lee KW, Baek SK, et al. Second-line chemotherapy versus supportive cancer treatment in advanced gastric cancer: a meta-analysis. Ann Oncol. 2013; 24:2850–4.

25. Lee KW, Lee JH, Kim JW, Kim JW, Ahn S, Kim JH. Population-based outcomes research on treatment patterns and impact of chemotherapy in older patients with metastatic gastric cancer. J Cancer Res Clin Oncol. 2016; 142:687–97.

26. Hwang IG, Ji JH, Kang JH, Lee HR, Lee HY, Chi KC, et al. A multi-center, open-label, randomized phase III trial of firstline chemotherapy with capecitabine monotherapy versus capecitabine plus oxaliplatin in elderly patients with advanced gastric cancer. J Geriatr Oncol. 2017; 8:170–5.

27. Saif MW, Makrilia N, Zalonis A, Merikas M, Syrigos K. Gastric cancer in the elderly: an overview. Eur J Surg Oncol. 2010; 36:709–17.

28. Wang J, Qu J, Li Z, Che X, Zhang J, Liu J, et al. A prognostic model in metastatic or recurrent gastric cancer patients with good performance status who received first-line chemotherapy. Transl Oncol. 2016; 9:256–61.

29. Kim JW, Im SA, Kim M, Cha Y, Lee KH, Keam B, et al. The prognostic significance of HER2 positivity for advanced gastric cancer patients undergoing first-line modified FOLFOX-6 regimen. Anticancer Res. 2012; 32:1547–53.

30. Al-Batran SE, Van Cutsem E, Oh SC, Bodoky G, Shimada Y, Hironaka S, et al. Quality-of-life and performance status results from the phase III RAINBOW study of ramucirumab plus paclitaxel versus placebo plus paclitaxel in patients with previously treated gastric or gastroesophageal junction adenocarcinoma. Ann Oncol. 2016; 27:673–9.