Is there a preferred platinum and fuoropyrimidine regimen for advanced HER2‑negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON–SEOM registry

• Aranzazu Arias Martinez ^[1] ; Eva Martínez de Castro ^[2] ; Javier Gallego ^[3] ; Virginia Arrazubi ^[4] ; Ana Custodio ^[5] ; Ana Fernández Montes ^[17] ; Marc Diez ^[18] ; Raquel Hernandez ^[6] ; María Luisa Limón ^[7] ; Juana María Cano ^[8] ; Rosario Vidal Tocino ^[9] ; Ismael Macias ^[19] ; Laura Visa ^[20] ; Marta Martin Richard ^[21] ; Tamara Sauri ^[21] ; Cinta Hierro ^[22] ; Mireia Gil ^[23] ; Paula Cerda ^[24] ; Elia Martínez Moreno ^[10] ; Nieves Martínez Lago ^[11] ; Antonio José Mérida García ^[25] ; Lucía Gómez González ^[12] ; Francisco Javier García Navalón ^[26] ; Maribel Ruiz Martín ^[13] ; Gema Marín ^[27] ; Flora López López ^[14] ; Ana Belen Ruperez Blanco ^[28] ; Alejandro Francisco Fernández ^[15] ; Paula Jimenez Fonseca ^[16] ; Alberto Carmona Bayonas ^[29] ; Felipe Alvarez Manceñido ^[16]
  1. [1] Universidad de Granada

     Universidad de Granada

     Granada, España

     
  2. [2] Hospital Universitario Marqués de Valdecilla

     Hospital Universitario Marqués de Valdecilla

     Santander, España

     
  3. [3] Hospital General Universitario de Elche

     Hospital General Universitario de Elche

     Elche, España

     
  4. [4] Hospital Universitario de Navarra

     Hospital Universitario de Navarra

     Pamplona, España

     
  5. [5] Hospital Universitario La Paz

     Hospital Universitario La Paz

     Madrid, España

     
  6. [6] Hospital Universitario de Canarias

     Hospital Universitario de Canarias

     San Cristóbal de La Laguna, España

     
  7. [7] Hospital Universitario Virgen del Rocío

     Hospital Universitario Virgen del Rocío

     Sevilla, España

     
  8. [8] Hospital General de Ciudad Real

     Hospital General de Ciudad Real

     Ciudad Real, España

     
  9. [9] Hospital Universitario de Salamanca

     Hospital Universitario de Salamanca

     Salamanca, España

     
  10. [10] Hospital de Fuenlabrada

      Hospital de Fuenlabrada

      Fuenlabrada, España

      
  11. [11] Complexo Hospitalario Universitario de Ferrol

      Complexo Hospitalario Universitario de Ferrol

      Ferrol, España

      
  12. [12] Hospital General Universitario de Alicante

      Hospital General Universitario de Alicante

      Alicante, España

      
  13. [13] Complejo Asistencial Universitario de Palencia

      Complejo Asistencial Universitario de Palencia

      Palencia, España

      
  14. [14] Hospital Universitario del Sureste

      Hospital Universitario del Sureste

      Arganda del Rey, España

      
  15. [15] Complexo Hospitalario Universitario de Pontevedra

      Complexo Hospitalario Universitario de Pontevedra

      Pontevedra, España

      
  16. [16] Hospital Universitario Central de Asturias

      Hospital Universitario Central de Asturias

      Oviedo, España

      
  17. [17] Medical Oncology Department, Complejo Hospitalario Universitario de Orense, Orense, Spain
  18. [18] Medical Oncology Department, Hospital Universitario Vall d’Hebron, VHIO, Barcelona, Spain
  19. [19] Medical Oncology Department, Hospital Universitario Parc Tauli, Sabadell, Spain
  20. [20] Medical Oncology Department, Hospital Universitario El Mar, Barcelona, Spain
  21. [21] Medical Oncology Department, Instituto Catalán de Oncología (ICO), L’Hospitalet de Llobregat, Barcelona, Spain
  22. [22] Medical Oncology Department, Instituto Catalán de Oncología (ICO)-Badalona, Barcelona; Badalona-Applied Research Group in Oncology (B-ARGO), Badalona, Spain
  23. [23] Medical Oncology Department, Hospital General Universitario de Valencia–Ciberonc CB16/12/0035, Valencia, Spain
  24. [24] Medical Oncology Department, Hospital Universitario Santa Creu y Sant Pau, Barcelona, Spain
  25. [25] Medical Oncology Department, Complejo Asistencial de Zamora, Zamora, Spain
  26. [26] Medical Oncology Department, Hospital Universitario de Son Llatzer, Mallorca, Spain
  27. [27] Medical Oncology Department, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
  28. [28] Medical Oncology Department, Hospital Universitario de Toledo, Toledo, Spain
  29. [29] Hematology and Medical Oncology Department, Hospital Universitario Morales Meseguer, University of Murcia, IMIB, Murcia, Spain

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• Localización: Clinical & translational oncology, ISSN 1699-048X, Vol. 26, Nº. 7, 2024, págs. 1674-1686
• Idioma: inglés
• Texto completo no disponible (Saber más ...)
• Resumen

  • Background The optimal chemotherapy backbone for HER2-negative advanced esophagogastric cancer, either in combination with targeted therapies or as a comparator in clinical trials, is uncertain. The subtle yet crucial diferences in platinumbased regimens' safety and synergy with combination treatments need consideration.

    Methods We analyzed cases from the AGAMENON–SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fuoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most efective and tolerable platinum and fuoropyrimidine-based chemotherapy regimen and to identify any prognostic factors.

    Results Among 1293 patients, 36% received either FOLFOX (n=468) or CAPOX (n=466), 20% CP (n=252), and 8% FP (n=107). FOLFOX signifcantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58–0.92, p=0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG–PS (Eastern Cooperative Oncology Group–Performance Status),>2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand–foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%).

    Conclusions FOLFOX shown better PFS than CP. Adverse efects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.