Оценка эффективности второй линии терапии при метастатическом раке желудка в реальной клинической практике — результаты многоцентрового ретроспективного исследования: опыт онкологической службы Москвы

Evaluation of the Efficacy of Second-Line Therapy for Metastatic Gastric Cancer in Real Clinical Practice - the Results of a Multicenter Retrospective Study: Experience of Moscow Oncology Service. (2025). Voprosy Onkologii, 70(6), 1189-1198. https://doi.org/10.37469/0507-3758-2024-70-6-1189-1198

Abstract

Introduction. Different combinations of drugs are currently used in the second line treatment of metastatic gastric cancer.

Aim. To compare progression-free survival (PFS) and overall survival (OS) in patients with metastatic gastric cancer who received various therapy options in the second line of treatment.

Materials and Methods. 384 patients with morphologically confirmed metastatic gastric cancer who had progressed after first-line treatment were selected from the Moscow registry. Three groups were formed: those receiving immune checkpoint inhibitor (ICI) therapy (n = 93), chemotherapy (chemo) (n = 82) and chemotherapy + ramucirumab (chemo + ramu) (n = 208). Treatment was carried out from 2018 to 2023. The median follow-up was 35.8 months.

Results. In the general group, there was an advantage in PFS in patients receiving ICT and chemo + ramu (4.3 months and 5.1 months, respectively) compared to the chemo group (4.0 months, p = 0.019 and 0.056, respectively). OS did not differ in any of the three groups (ICI — 8.5 months, chemo — 10.1 months, chemo + ramu — 10.7 months, p = 0.4 and 0.43 months, respectively, compared to the chemo group). The level of CPS did not affect efficacy in the ICI arm (PFS for CPS 0-9 — 3.9 months, for CPS≥10 — 4.2 months, p = 0.61; OS — 6.6 months and 6.9 months, respectively, p = 0.875). In the presence of MSI (n = 27) in the ICI group, PFS was 11.1 months vs. 3.9 months, p = 0.068, OS — 14.2 months vs. 5.4 months, p = 0.162, compared to MSS. When compared to patients with MSI who received chemo + ramu (n = 14), these differences were equalised (PFS — 11.1 months vs. 3.8 months, p = 0.13, OS — 14.2 months vs. 16.0 months, p = 0.75). In the chemo + ramu groups, the use of two cytostatic drugs improved PFS but not OS compared to monotherapy (PFS 5.8 and 4.0 months, p = 0.009, OS — 10.8 and 10.1 months, p = 0.79). Propensity score matching showed the same results in the general group.

Conclusion. Doublet combinations, the addition of ramucirumab or the use of ICT did not improve outcomes compared to monotherapy.

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