The Korean Journal of Medicine

  • 제87권5호
  • /
  • Pages.521-529
  • /
  • 2014
  • /
  • 1738-9364(pISSN)
  • /
  • 2289-0769(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
권호 표지
DOI QR코드

DOI QR Code

진행성 노인 위암에 대한 항암요법

Chemotherapy for Advanced Gastric Cancer in Elderly Patients

  • 김미정 (국립암센터 위암센터) ;
  • 박숙련 (울산대학교 의과대학 서울아산병원 내과)
  • Kim, Mi-Jung (Center for Gastric Cancer, National Cancer Center) ;
  • Park, Sook Ryun (Division of Oncology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2014.11.01
⟨ 이전 논문 다음 논문 ⟩

초록

Cancer, including gastric cancer, occurs predominantly in older patients. Although there is no single internationally accepted standard chemotherapy regimen for unresectable or metastatic gastric cancer (MGC), doublet combination chemotherapy using fluoropyrimidine and platinum is regarded as the reference treatment. However, most of the clinical trials that were based on the current treatment guidelines were performed in patients < 70 years of age with good performance status (PS). Therefore, the clinical application of these guidelines to elderly individuals is limited. The available data suggest that older patients with good PS are able to tolerate the same chemotherapy regimens as younger patients with MGC, and that they achieve a similar efficacy. In contrast, some studies showed that the same efficacy was achieved at the expense of increased toxicity in older patients, emphasizing the importance of patient selection. Many studies have actively investigated elderly patients with MGC, including randomized phase 3 studies comparing fluoropyrimidine and platinum doublets with fluoropyrimidine alone. Although an advanced age alone should not preclude the use of effective chemotherapy in MGC, more data regarding age-specific clinical trials are needed to guide optimal treatment in elderly patients.

키워드

참고문헌

  1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 2011;61:69-90. https://doi.org/10.3322/caac.20107
  2. Jung KW, Won YJ, Kong HJ, Oh CM, Lee DH, Lee JS. Cancer statistics in Korea: incidence, mortality, survival, and prevalence in 2011. Cancer Res Treat 2014;46:109-123. https://doi.org/10.4143/crt.2014.46.2.109
  3. Parkin DM, Muir CS. Cancer incidence in five continents. Comparability and quality of data. IARC Sci Publ 1992;(120):45-173.
  4. Glimelius B, Ekström K, Hoffman K, et al. Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 1997;8:163-168. https://doi.org/10.1023/A:1008243606668
  5. Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 1993;72:37-41. https://doi.org/10.1002/1097-0142(19930701)72:1<37::AID-CNCR2820720109>3.0.CO;2-P
  6. Pyrhonen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 1995;71:587-591. https://doi.org/10.1038/bjc.1995.114
  7. Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: a systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006;24:2903-2909. https://doi.org/10.1200/JCO.2005.05.0245
  8. Kang JH, Lee SI, Lim do H, et al. Salvage chemotherapy for pretreated gastric cancer: a randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol 2012;30:1513-1518. https://doi.org/10.1200/JCO.2011.39.4585
  9. Ford HE, Marshall A, Bridgewater JA, et al. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): an open-label, phase 3 randomised controlled trial. Lancet Oncol 2014;15:78-86. https://doi.org/10.1016/S1470-2045(13)70549-7
  10. Talarico L, Chen G, Pazdur R. Enrollment of elderly patients in clinical trials for cancer drug registration: a 7-year experience by the US Food and Drug Administration. J Clin Oncol 2004;22:4626-4631. https://doi.org/10.1200/JCO.2004.02.175
  11. Saltzstein SL, Behling CA. 5- and 10-year survival in cancer patients aged 90 and older: a study of 37,318 patients from SEER. J Surg Oncol 2002;81:113-116. https://doi.org/10.1002/jso.10160
  12. Extermann M. Management issues for elderly patients with breast cancer. Curr Treat Options Oncol 2004;5:161-169. https://doi.org/10.1007/s11864-004-0048-9
  13. Chen H, Cantor A, Meyer J, et al. Can older cancer patients tolerate chemotherapy? A prospective pilot study. Cancer 2003;97:1107-1114. https://doi.org/10.1002/cncr.11110
  14. Christman K, Muss HB, Case LD, Stanley V. Chemotherapy of metastatic breast cancer in the elderly. The Piedmont Oncology Association experience [see comment]. JAMA 1992;268:57-62. https://doi.org/10.1001/jama.1992.03490010059030
  15. Sargent DJ, Goldberg RM, Jacobson SD, et al. A pooled analysis of adjuvant chemotherapy for resected colon cancer in elderly patients. N Engl J Med 2001;345:1091-1097. https://doi.org/10.1056/NEJMoa010957
  16. Kim NK, Park YS, Heo DS, et al. A phase III randomized study of 5-fluorouracil and cisplatin versus 5-fluorouracil, doxorubicin, and mitomycin C versus 5-fluorouracil alone in the treatment of advanced gastric cancer. Cancer 1993;71:3813-3818. https://doi.org/10.1002/1097-0142(19930615)71:12<3813::AID-CNCR2820711205>3.0.CO;2-5
  17. Webb A, Cunningham D, Scarffe JH, et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997;15:261-267. https://doi.org/10.1200/JCO.1997.15.1.261
  18. Kang YK, Kang WK, Shin DB, et al. Capecitabine/cisplatin versus 5-fluorouracil/cisplatin as first-line therapy in patients with advanced gastric cancer: a randomised phase III noninferiority trial. Ann Oncol 2009;20:666-673. https://doi.org/10.1093/annonc/mdn717
  19. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2008;358:36-46. https://doi.org/10.1056/NEJMoa073149
  20. Ajani JA, Rodriguez W, Bodoky G, et al. Multicenter phase III comparison of cisplatin/S-1 with cisplatin/infusional fluorouracil in advanced gastric or gastroesophageal adenocarcinoma study: the FLAGS trial. J Clin Oncol 2010;28:1547-1553. https://doi.org/10.1200/JCO.2009.25.4706
  21. Al-Batran SE, Hartmann JT, Probst S, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol 2008;26:1435-1442. https://doi.org/10.1200/JCO.2007.13.9378
  22. Nardi M, Azzarello D, Maisano R, et al. FOLFOX-4 regimen as fist-line chemotherapy in elderly patients with advanced gastric cancer: a safety study. J Chemother 2007;19:85-89. https://doi.org/10.1179/joc.2007.19.1.85
  23. Goldberg RM, Tabah-Fisch I, Bleiberg H, et al. Pooled analysis of safety and efficacy of oxaliplatin plus fluorouracil/leucovorin administered bimonthly in elderly patients with colorectal cancer. J Clin Oncol 2006;24:4085-4091. https://doi.org/10.1200/JCO.2006.06.9039
  24. Boku N, Yamamoto S, Fukuda H, et al. Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol 2009;10:1063-1069. https://doi.org/10.1016/S1470-2045(09)70259-1
  25. Koizumi W, Narahara H, Hara T, et al. S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol 2008;9:215-221. https://doi.org/10.1016/S1470-2045(08)70035-4
  26. Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol 2006;24:4991-4997. https://doi.org/10.1200/JCO.2006.06.8429
  27. Dank M, Zaluski J, Barone C, et al. Randomized phase III study comparing irinotecan combined with 5-fluorouracil and folinic acid to cisplatin combined with 5-fluorouracil in chemotherapy naive patients with advanced adenocarcinoma of the stomach or esophagogastric junction. Ann Oncol 2008;19:1450-1457. https://doi.org/10.1093/annonc/mdn166
  28. Narahara H, Iishi H, Imamura H, et al. Randomized phase III study comparing the efficacy and safety of irinotecan plus S-1 with S-1 alone as first-line treatment for advanced gastric cancer (study GC0301/TOP-002). Gastric Cancer 2011;14:72-80. https://doi.org/10.1007/s10120-011-0009-5
  29. Koizumi W, Kim YH, Fujii M, et al. Addition of docetaxel to S-1 without platinum prolongs survival of patients with advanced gastric cancer: a randomized study (START). J Cancer Res Clin Oncol 2014;140:319-328. https://doi.org/10.1007/s00432-013-1563-5
  30. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010;376:687-697. https://doi.org/10.1016/S0140-6736(10)61121-X
  31. Hecht JR, Bang YJ, Qin S, et al. Lapatinib in combination with capecitabine plus oxaliplatin (CapeOx) in HER2-positive advanced or metastatic gastric, esophageal, or gastroesophageal adenocarcinoma (AC): The TRIO-013/LOGiC Trial. J Clin Oncol 2013;31(Suppl):LBA4001. https://doi.org/10.1200/jco.2013.31.18_suppl.lba4001
  32. Ohtsu A, Shah MA, Van Cutsem E, et al. Bevacizumab in combination with chemotherapy as first-line therapy in advanced gastric cancer: a randomized, double-blind, placebocontrolled phase III study. J Clin Oncol 2011;29:3968-3976. https://doi.org/10.1200/JCO.2011.36.2236
  33. Lordick F, Kang YK, Chung HC, et al. Capecitabine and cisplatin with or without cetuximab for patients with previously untreated advanced gastric cancer (EXPAND): a randomised, open-label phase 3 trial. Lancet Oncol 2013;14:490-499. https://doi.org/10.1016/S1470-2045(13)70102-5
  34. Waddell T, Chau I, Cunningham D, et al. Epirubicin, oxaliplatin, and capecitabine with or without panitumumab for patients with previously untreated advanced oesophagogastric cancer (REAL3): a randomised, open-label phase 3 trial. Lancet Oncol 2013;14:481-489. https://doi.org/10.1016/S1470-2045(13)70096-2
  35. Trumper M, Ross PJ, Cunningham D, et al. Efficacy and tolerability of chemotherapy in elderly patients with advanced oesophago-gastric cancer: A pooled analysis of three clinical trials. Eur J Cancer 2006;42:827-834. https://doi.org/10.1016/j.ejca.2005.08.044
  36. Jatoi A, Foster NR, Egner JR, et al. Older versus younger patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction, and stomach: a pooled analysis of eight consecutive North Central Cancer Treatment Group (NCCTG) trials. Int J Oncol 2010;36:601-606.
  37. Al-Batran SE, Pauligk C, Homann N, et al. The feasibility of triple-drug chemotherapy combination in older adult patients with oesophagogastric cancer: a randomised trial of the Arbeitsgemeinschaft Internistische Onkologie (FLOT65+). Eur J Cancer 2013;49:835-842. https://doi.org/10.1016/j.ejca.2012.09.025
  38. Graziano F, Santini D, Testa E, et al. A phase II study of weekly cisplatin, 6S-stereoisomer leucovorin and fluorouracil as first-line chemotherapy for elderly patients with advanced gastric cancer. Br J Cancer 2003;89:1428-1432. https://doi.org/10.1038/sj.bjc.6601280
  39. Santini D, Graziano F, Catalano V, et al. Weekly oxaliplatin, 5-fluorouracil and folinic acid (OXALF) as first-line chemotherapy for elderly patients with advanced gastric cancer: results of a phase II trial. BMC Cancer 2006;6:125. https://doi.org/10.1186/1471-2407-6-125
  40. Tsushima T, Hironaka S, Boku N, et al. Comparison of safety and efficacy of S-1 monotherapy and S-1 plus cisplatin therapy in elderly patients with advanced gastric cancer. Int J Clin Oncol 2013;18:10-16. https://doi.org/10.1007/s10147-011-0335-y
  41. Terazawa T, Iwasa S, Takashima A, et al. Impact of adding cisplatin to S-1 in elderly patients with advanced gastric cancer. J Cancer Res Clin Oncol 2013;139:2111-2116. https://doi.org/10.1007/s00432-013-1537-7
  42. Lee JL, Kang YK, Kang HJ, et al. A randomised multicentre phase II trial of capecitabine vs S-1 as first-line treatment in elderly patients with metastatic or recurrent unresectable gastric cancer. Br J Cancer 2008;99:584-590. https://doi.org/10.1038/sj.bjc.6604536
  43. Koizumi W, Akiya T, Sato A, et al. Phase II study of S-1 as first-line treatment for elderly patients over 75 years of age with advanced gastric cancer: the Tokyo Cooperative Oncology Group study. Cancer Chemother Pharmacol 2010;65:1093-1099. https://doi.org/10.1007/s00280-009-1114-6
  44. Park SR, Kong SY, Kim MH, et al. A randomized phase II study of S-1 versus capecitabine as first-line chemotherapy in elderly metastatic gastric cancer patients with/without poor performance status: clinical and pharmacogenetic results. Presented at AACR 104th Annual Meeting, April 6-10, 2013, Washington, DC.