Resumen de Is there a preferred platinum and fuoropyrimidine regimen for advanced HER2‑negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON–SEOM registry
Aránzazu Arias Martínez, Eva Martínez de Castro, Javier Gallego Plazas, Virginia Arrazubi Arrula, Ana Custodio, Ana Fernández Montes, Marc Díez Garcia, Raquel Hernández San Gil, María Luisa Limón, Juana María Cano Cano, María del Rosario Vidal Tocino, Ismael Macías Declara, Laura Visa, M. Martin Richard, Tamara Saurí Nadal, Cinta Hierro Carbó, Mireia Gil Raga, Paula Cerda, Elia Martínez Moreno, Nieves Martínez Lago, Antonio José Mérida García, Lucía Gómez González, Francisco Javier García Navalón, Maribel Ruiz Martín, Gema Marín Zafra, Flora López López, Ana Belen Rupérez Blanco, Alejo Fernández Muinelo, P. Jiménez Fonseca, Alberto Carmona Bayonas, Felipe Alvarez Manceñido
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.
