Combination Chemotherapy Mainly Used in Young Patients Also Effective for Elderly Gastric Cancer Patients

Seoul National University Bundang Hospital and Boramae Hospital Professors' Team
Significant Differences in Metastatic and Recurrent Clinical Cases
"Active Consideration of Combination Chemotherapy Needed"

A study has found that combination chemotherapy helps improve survival periods in metastatic and recurrent gastric cancer patients aged 70 and older.

[Image provided by Pixabay]

Bundang Seoul National University Hospital announced on the 18th that a joint research team led by Dr. Lee Geun-wook from the Department of Hematology-Oncology and Professor Choi In-sil from the Department of Hematology-Oncology at Seoul Metropolitan Government Boramae Medical Center published these findings.

Gastric cancer, ranked third in global cancer mortality, has an increased risk of occurrence with age, with more than half of patients being 65 or older. The standard treatment for metastatic or recurrent gastric cancer patients is combination chemotherapy, which is highly effective but has a higher likelihood of side effects, so it has mainly been used for relatively younger patients. Consequently, its use has been limited for patients aged 70 and above, and due to the lack of related studies, there has been no clear treatment guideline.

The research team conducted a multicenter phase 3 clinical trial comparing the efficacy and safety of combination chemotherapy and single-agent chemotherapy in metastatic and recurrent gastric cancer patients aged 70 and older. From 2014 to 2019, 104 elderly gastric cancer patients were randomly assigned to receive either combination chemotherapy or single-agent chemotherapy, and the effects and side effects were compared after treatment.

The study results showed that the median overall survival period was 11.5 months for the combination chemotherapy group and 7.5 months for the single-agent chemotherapy group, with the combination chemotherapy group surviving 4 months longer. Although fewer patients were enrolled than initially planned, so the survival difference did not reach statistical significance, the difference was clinically meaningful. Notably, among patients aged 70 to 74, the survival periods were 15.9 months versus 7.2 months for the combination and single-agent groups respectively, showing a difference of 8.7 months?more than double.

Progression-free survival, an important indicator in cancer treatment representing the duration during which the cancer does not worsen, was 5.6 months in the combination chemotherapy group, about 2 months longer than in the single-agent chemotherapy group, and this difference was statistically significant. While the combination chemotherapy group experienced higher frequencies of some side effects such as thrombocytopenia and diarrhea, the incidence of severe side effects of grade 3 or higher was similar between groups, and there was no difference in quality of life survey results.

Accordingly, combination chemotherapy was found to be effective even in elderly patients, especially those aged 74 or younger, according to the research team’s conclusion. Dr. Lee, the first author of the study, stated, "Previously, comparative clinical trial results for patients aged 70 and above were very rare, so combination chemotherapy prescriptions were often limited. With increasing average life expectancy and a growing number of elderly gastric cancer patients, this study expands the scope of combination chemotherapy treatment, enabling more effective therapy."

Professor Choi, the principal investigator, explained, "Conducting clinical trials on elderly metastatic cancer patients is very challenging, but this important study provides our own evidence that can be used as a basis for clinical care of elderly gastric cancer patients requiring chemotherapy."

The study results were published in 'Cancer Research and Treatment,' the official SCI medical journal of the Korean Cancer Association.

Professor Lee Geun-wook (left) of the Department of Hematology and Oncology at Bundang Seoul National University Hospital and Professor Choi In-sil of the Department of Hematology and Oncology at Seoul National University Hospital. [Photo provided by Bundang Seoul National University Hospital]

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