A retrospective analysis of second-line chemotherapy in patients with advanced gastric cancer

The decision for administering second-line chemotherapy was, in most cases, at the discretion of the physician. Seven-hundred twenty-five (50%) received second-line chemotherapy after first-line failure. Univariate and multivariate analyses were performed on the recognized baseline parameters for survival.At the time of initiating second-line chemotherapy, the patients' median age was 56 years (range, 22 to 86) and 139 (19%) had an Eastern Cooperative Oncology Group (ECOG) performance status of 2 or more. Seven (1%) complete and 108 (15%) partial responses to second-line chemotherapy were observed for an overall response rate of 16% (95% confidence interval [CI], 13 to 19%). The median progression-free and overall survivals, calculated from the start of second-line chemotherapy, were 2.9 months (95% CI, 2.6 to 3.3) and 6.7 months (95% CI, 5.8 to 7.5), respectively. Multivariate analysis revealed that low baseline hemoglobin level (hazard ratio [HR], 0.74; 95% CI 0.61–0.90) and a poor performance status (HR, 0.66; 95% CI, 0.52–0.83) were independent negative prognostic factors for overall survival.Performance status, along with baseline hemoglobin level, could be used to identify the subgroup of patients most likely to benefit from second-line chemotherapy for AGC.Gastric cancer is the most frequently occurring malignancy in Korea, and is one of the main causes of cancer death [1]. For patients with recurrent, metastatic, or advanced gastric cancer (AGC), chemotherapy can improve survival, and possibly, provide significant palliation of symptoms [2,3]. However, over half of patients with AGC who received chemotherapy failed to achieve response and even in these responders, the duration of responses was as short as a few months [4]. Given no standard salvage treatment available in those patients, limited investigation on second-line chemotherapy after first-line failure has been performed [5-7]. The sample size of most studies was small and randomized trial comparing