Is there a preferred platinum and fluoropyrimidine regimen for advanced HER2-negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON-SEOM registry.
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Arias-Martinez Aranzazu, Martínez de Castro Eva, Gallego Javier, Arrazubi Virginia, Custodio Ana, Fernández Montes Ana, Diez Marc, Hernandez Raquel, Limón María Luisa, Cano Juana María, Vidal-Tocino Rosario, Macias Ismael, Visa Laura, Martin Richard Marta, Sauri Tamara, Hierro Cinta, Gil Mireia, Cerda Paula, Martínez Moreno Elia, Martínez Lago Nieves, Mérida-García Antonio José, Gómez González Lucía, García Navalón Francisco Javier, Ruiz Martín Maribel, Marín Gema, López-López Flora, Ruperez Blanco Ana Belen, Fernández Alejandro Francisco, Jimenez-Fonseca Paula, Carmona-Bayonas Alberto, Alvarez-Manceñido Felipe
Аннотация
METHODS: We analyzed cases from the AGAMENON-SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fluoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most effective and tolerable platinum and fluoropyrimidine-based chemotherapy regimen and to identify any prognostic factors.
RESULTS: Among 1293 patients, 36% received either FOLFOX (n = 468) or CAPOX (n = 466), 20% CP (n = 252), and 8% FP (n = 107). FOLFOX significantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58-0.92, p = 0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG-PS (Eastern Cooperative Oncology Group-Performance Status), > 2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand-foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%).
CONCLUSIONS: FOLFOX shown better PFS than CP. Adverse effects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.