First-line treatment of patients with HER2-positive metastatic gastric and gastroesophageal junction cancer

Selin Aktürk Esen; Yakup  Ergun; Cihan   Erol; Rukiye   Arikan; Muhammed Muhiddin  Er; Muhammed Mustafa  Atci; Atakan  Topçu; Gökhan  Uçar; Baran  Akagündüz; Musa Bariş Aykan; Miraç  Özen; Naziyet Köse  Baytemur; Melike   Özçelik; Elif  Şahin; Denizcan  Güven; Serkan  Menekşe; Naziye Ak; Fatih  Teker; Engin  Kut; Teoman Şakalar; Özkan  Alan; Turgut  Kaçan; Nazim Serdar  Turhal; Saadettin  Kiliçkap; Sema  Türker; Mehmet Ali Nahit  Şendur; Osman   Köstek; Mustafa Karaağaç; Abdullah  Sakin; Haci Mehmet  Türk; Dilek  Çağlayan; Şener  Cihan; Yusuf  Açikgöz; Doğan  Uncu

doi:10.17305/bjbms.2021.7069

Authors

Selin Aktürk Esen Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey
Yakup Ergun Department of Medical Oncology, Batman Training And Research Hospital, Batman, Turkey https://orcid.org/0000-0003-4784-6743
Cihan Erol Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey https://orcid.org/0000-0003-3155-8798
Rukiye Arikan Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey https://orcid.org/0000-0003-2688-1515
Muhammed Muhiddin Er Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0002-0583-0295
Muhammed Mustafa Atci Department of Medical Oncology, Prof. Dr. Cemil Taşcioğlu City Hospital, Istanbul, Turkey
Atakan Topçu Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University Istanbul, Turkey https://orcid.org/0000-0002-3634-4820
Gökhan Uçar Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey https://orcid.org/0000-0002-7649-1075
Baran Akagündüz Department of Medical Oncology, Erzincan Binali Yildirim University, Erzincan, Turkey
Musa Bariş Aykan Department of Medical Oncology, Gulhane Medical Faculty, Health Sciences University, Ankara, Turkey https://orcid.org/0000-0001-7538-9119
Miraç Özen Department of Medical Oncology, Faculty of Medicine, Sakarya University Sakarya, Turkey https://orcid.org/0000-0002-1934-0190
Naziyet Köse Baytemur Department of Medical Oncology, Memorial Ankara Hospital, Ankara, Turkey https://orcid.org/0000-0002-3587-2517
Melike Özçelik Department of Medical Oncology, Ümraniye Training And Research Hospital, İstanbul, Turkey https://orcid.org/0000-0003-0406-715X
Elif Şahin Department of Medical Oncology, Faculty of Medicine, Kocaeli University, Kocaeli, Turkey https://orcid.org/0000-0002-1976-3951
Denizcan Güven Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey https://orcid.org/0000-0002-6924-9467
Serkan Menekşe Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey https://orcid.org/0000-0002-2134-2128
Naziye Ak Department of Medical Oncology, Yozgat City Hospital, Yozgat, Turkey https://orcid.org/0000-0001-5790-7066
Fatih Teker Department of Medical Oncology, Faculty of Medicine, Gaziantep University, Gaziantep, Turkey
Engin Kut Department of Medical Oncology, Manisa City Hospital, Manisa, Turkey https://orcid.org/0000-0002-5328-5607
Teoman Şakalar Department of Medical Oncology, Kahramanmaraş Necip Fazil City Hospital, Kahramanmaraş, Turkey https://orcid.org/0000-0003-2749-9414
Özkan Alan Department of Medical Oncology, Tekirdağ İsmail Fehmi Cumalioğlu City Hospital, Tekirdağ, Turkey https://orcid.org/0000-0002-6635-2012
Turgut Kaçan Department of Medical Oncology, Yüksek İhtisas Training And Research Hospital, Health Sciences University Bursa, Bursa, Turkey
Nazim Serdar Turhal Department of Medical Oncology, Anadolu Health Center, İstanbul, Turkey https://orcid.org/0000-0002-1013-5676
Saadettin Kiliçkap Department of Medical Oncology, Faculty of Medicine, Hacettepe University, Ankara, Turkey https://orcid.org/0000-0003-1637-7390
Sema Türker Department of Medical Oncology, Zonguldak Atatürk State Hospital, Zonguldak, Turkey https://orcid.org/0000-0001-9040-7266
Mehmet Ali Nahit Şendur Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey https://orcid.org/0000-0001-7021-6139
Osman Köstek Department of Medical Oncology, Faculty of Medicine, Marmara University, Istanbul, Turkey https://orcid.org/0000-0002-1901-5603
Mustafa Karaağaç Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0003-4533-0620
Abdullah Sakin Department of Medical Oncology, Prof. Dr. Cemil Taşcioğlu City Hospital, Istanbul, Turkey https://orcid.org/0000-0003-2538-8569
Haci Mehmet Türk Department of Medical Oncology, Faculty of Medicine, Bezmialem Vakif University Istanbul, Turkey https://orcid.org/0000-0003-2206-8148
Dilek Çağlayan Department of Medical Oncology, Meram Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey https://orcid.org/0000-0003-4629-6815
Şener Cihan Department of Medical Oncology, Prof. Dr. Cemil Taşcioğlu City Hospital, Istanbul, Turkey
Yusuf Açikgöz Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey https://orcid.org/0000-0002-0360-7938
Doğan Uncu Department of Medical Oncology, Ankara City Hospital, Ankara, Turkey https://orcid.org/0000-0002-0929-3271

DOI:

https://doi.org/10.17305/bjbms.2021.7069

Keywords:

CF, FOLFOX, gastric cancer, gastroesophageal junction cancer, trastuzumab

Abstract

Fluoropyrimidine+cisplatin/oxaliplatin+trastuzumab therapy is recommended for the first-line treatment of HER2-positive metastatic gastric adenocarcinoma. However, there is no comprehensive study on which platinum-based treatment should be preferred. This study aimed to compare the treatment response and survival characteristics of patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) cancer who received fluorouracil, oxaliplatin, and leucovorin (mFOLFOX)+trastuzumab or cisplatin and fluorouracil (CF)+trastuzumab as first-line therapy. It was a multicenter, retrospective study of the Turkish Oncology Group, which included 243 patients from 21 oncology centers. There were 113 patients in the mFOLFOX+trastuzumab arm and 130 patients in the CF+trastuzumab arm. The median age was 62 years in the mFOLFOX+trastuzumab arm and 61 years in the CF+trastuzumab arm (P = 0.495). 81.4% of patients in the mFOLFOX+trastuzumab arm and 83.1% in the CF+trastuzumab arm had gastric tumor localization (P = 0.735). The median progression-free survival (PFS) was significantly higher in the mFOLFOX+trastuzumab arm (9.4 months vs. 7.3 months, P = 0.024). The median overall survival (OS) was similar in both groups (18.4 months vs. 15.1 months, P = 0.640). Maintenance trastuzumab was continued after chemotherapy in 101 patients. In this subgroup, the median OS was 23.3 months and the median PFS was 13.3 months. In conclusion, mFOLFOX+trastuzumab is similar to CF+trastuzumab in terms of the median OS, but it is more effective in terms of the median PFS in the first-line treatment of HER2-positive metastatic gastric and GEJ cancer. The choice of treatment should be made by considering the prominent toxicity findings of the chemotherapy regimens.