Progression-free survival with maintenance therapy with fluoropyrimidine in patients with advanced gastric and gastroesophageal junction cancer in a third level hospital in Mexico City

Fluoropyrimidine with platinum based chemotherapy has become the standard of care for advanced gastric and gastroesophageal cancer. Trials in colon cancer show that induction chemotherapy followed by maintenance chemotherapy is an efficacious strategy to maximize clinical response while miminizing toxicity. The current retrospective study aims to evaluate the efficacy and tolerability of maintenance chemotherapy with fluoropyrimidine in advanced gastric and gastroesophageal junction cancer.

A retrospective analysis of patients with metastatic gastric and Gastroesophageal Junction Cancer treated with fluoropyrimidine and platinum chemotherapy between 2017-2022 was performed. Patients who achieved at least stable disease after initial induction treatment were included. After at least 3 cycles of induction chemotherapy, the patients received maintenance chemotherapy with fluoropyrimidine (capecitabine or 5-FU). Endpoint was progression-free survival and toxicities.

In total 75 patients were included, the median age was 60 years (range 28-86), 53% were men. 64% had ECOG 1. Unresectable locally advanced disease corresponded to a lower percentage in 18.7%, and metastatic disease in 81.3%. The most frequent site of metastasis was the peritoneum in 59%, followed by lymph node and liver. The most frequently used first-line chemotherapy scheme was FOLFOX in 36%, followed by XELOX in 34% and FLOT in 18%. The median number of cycles was 12, with a range of (3-20). 65.3% had a stable disease, 28% had partial response and 6.7% a complete response. The most frequently used maintenance treatment was capecitabine in 77.3% of the patients and 5-FU in the rest. The most frequent toxicity was hand-foot syndrome in 53.3%, followed by fatigue and diarrhea. The most frequent grade 3-4 toxicities were anemia and vomiting reported in 2.7%. The median progression-free survival was 12 months for the entire cohort.

Maintenance therapy following induction fluoropyripimidine and platinum-based therapy is associated with long progression-free survival and improved toxicity profile.

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All authors have declared no conflicts of interest.