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Real-world outcomes of third-line immune checkpoint inhibitors versus irinotecan-based chemotherapy in patients with advanced gastric cancer: a Korean, multicenter study (KCSG ST22-06)open access

Authors
Lim, Sung HeeLee, Keun-WookKim, Jae-JoonIm, Hyeon-SuKim, In-HoHan, Hye SookKoo, Dong-HoeCho, Jang HoMaeng, Chi HoonLee, Min-YoungLee, Hyo JinKim, Jwa HoonPark, Sang GonJung, Joo YoungShin, Seong-HoonKim, Ki HyangKim, HyeyeongOh, So YeonKang, MinsuJung, MinkyuRha, Sun Young
Issue Date
Feb-2024
Publisher
BMC
Keywords
Gastric cancer; Third-line treatment; Irinotecan; Nivolumab; Pembrolizumab
Citation
BMC CANCER, v.24, no.1
Journal Title
BMC CANCER
Volume
24
Number
1
URI
https://scholarworks.bwise.kr/sch/handle/2021.sw.sch/26328
DOI
10.1186/s12885-024-11972-w
ISSN
1471-2407
1471-2407
Abstract
Background Immune checkpoint inhibitor (ICI) or irinotecan-based chemotherapy is frequently used after failure of second-line paclitaxel plus ramucirumab treatment for patients with locally advanced unresectable or metastatic advanced gastric cancer (AGC). This study aimed to compare the efficacy between ICI and irinotecan-based chemotherapy as third-line treatment in patients with AGC. Methods We retrospectively reviewed patients with AGC, whose third-line treatment started between July 2019 and June 2021 at 17 institutions in Korea. The ICI group included patients who received nivolumab or pembrolizumab, and the irinotecan-based chemotherapy group included patients who received irinotecan or FOLFIRI (5-fluorouracil, leucovorin and irinotecan). Results A total of 363 patients [n = 129 (ICI) and n = 234 (irinotecan-based chemotherapy)] were analyzed. The median progression-free survival was 2.3 and 2.9 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.802). The median overall survival (OS) was 5.5 and 6.0 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.786). For all patients included in this study, multivariable analysis showed that weight loss, peritoneal metastasis, low serum sodium or albumin, and short duration of second-line treatment were associated with inferior OS (p < 0.05). ICI showed significantly longer OS than irinotecan-based chemotherapy in patients without peritoneal metastasis. Whereas ICI showed significantly shorter OS in patients without PD-L1 expression than irinotecan-based chemotherapy. Conclusions No significant difference in survival outcome was observed between ICI and irinotecan-based chemotherapy as third-line treatment for AGC patients. ICI might be preferred for patients without peritoneal metastasis and irinotecan-based chemotherapy for patients with tumors without PD-L1 expression.
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