Outcomes of advanced gastric cancer patients treated with at least three lines of systemic chemotherapy

Background. Second-line therapy has consistently demon-strated survival benefit if compared with best supportive care; however, there is limited evidence whether further lines of treatment may improve the prognosis of advanced gastric can-cer (AGC) patients. Materials and Methods. Starting from a real-world cohort of 868 AGC patients, we retrospectively analyzed baseline para-meters, tumor characteristics, and treatment data of those treated with at least three lines. Categorical features were described through cross-tables and chi-square test. We explored the impact of treatment intensity and progression-free survival (PFS) experienced in previous lines on PFS and overall survival in third-line by uni-and multivariate Cox regres-sion models and described by Kaplan-Meier estimator plot with log-rank test. Results. Overall, 300 patients were included in the analysis. The most common site of primary tumor was gastric body; 45.3% of cancers had an intestinal histotype, 14% were human epider-mal growth receptor 2 positive. In third-line, 45.7% of patients received a single-agent chemotherapy, 49.7% a com-bination regimen. Patients who had experienced a first-line PFS 6.9 months had a better prognosis compared with those who had achieved a shorter one. Consistently, a second-line PFS 3.5 months positively influenced the prog-nosis. Patients receiving a third-line combination regimen had better outcomes compared with those treated with a single-agent chemotherapy. Conclusion. Our real-world study confirms that selected AGC patients may receive third-line treatment. Longer PFS in previ-ous lines or a more intense third-line treatment positively influ-enced prognosis. Further efforts are warranted to define the best therapeutic sequences, and to identify the optimal candi-date for treatment beyond second-line. The Oncologist 2017;22:1–7 Implications for Practice: The benefit of third-line treatment to advanced gastric cancer patients is controversial. Our study depicts a real scenario of the clinical practice in Italy, confirming that a non-negligible proportion of patients receive a third-line therapy. Longer progression-free survival in previous treatment lines or higher third-line treatment intensity positively influenced prognosis. Including a large number of real-world patients, our study provides information on third-line treatment from the daily clinical practice; moreover, its results help in defining the best therapeutic sequence and offer some hints to select the optimal candidate for treatment beyond second-line.