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Zhu Y, Liu K, Zhu H, Wu H. Immune checkpoint inhibitors plus chemotherapy for HER2-negative advanced gastric/gastroesophageal junction cancer: a cost-effectiveness analysis. Therap Adv Gastroenterol 2023; 16:17562848231207200. [PMID: 37928895 PMCID: PMC10624011 DOI: 10.1177/17562848231207200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/19/2023] [Indexed: 11/07/2023] Open
Abstract
Background Nivolumab plus chemotherapy (NC) was recently approved as the first-line intervention for human epidermal growth factor receptor 2-negative advanced gastric/gastroesophageal junction cancer (GC/GEJC). Moreover, in the latest KEYNOTE-859 (NCT03675737), pembrolizumab plus chemotherapy (PC) was demonstrated to produce remarkable patient survival outcomes. Objectives The clinicians and patients need to assess NC and PC preference for cancer drugs. Design The cost-effective analysis. Methods In an economic assessment of the United States, United Kingdom, and Chinese healthcare systems using a Markov model simulated patients with GC/GEJC, two treatment decision branches with three health states and a tracked time horizon of 15 years were developed. The overall cost and efficacy outcomes of first-line strategies PC and NC were evaluated at willingness-to-pay (WTP) thresholds of different national, including life-years (LYs), quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and incremental net-health benefit (INHB). Sensitivity and subgroup analyses were considered. Results Given a WTP threshold of $150,000, $60,161, and $37,653 per QALY in the United States, United Kingdom, and China, respectively, both PC and NC achieved QALYs of 1.67 and 1.65 (2.51 and 2.48 LYs), 1.65 and 1.63 (2.48 and 2.45 LYs), and 1.60 and 1.58 (2.40 and 2.37 LYs), with total costs of $242,444 and $232,617, $148,367 and $127,737, and $16,693 and $24,016, respectively. Based on our sensitivity analysis, the programmed death-1 inhibitors cost produced the largest impact on the outcome. In addition, the cost-effectiveness probabilities of PC were 38.3%, 4.1%, and 100% in the three aforementioned countries, respectively. Conclusion In the case of the Chinese payers' perspective, PC appeared more dominant as first-line therapy for advanced GC/GEJC patients, whereas NC was preferred in the United States and United Kingdom.
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Affiliation(s)
- Youwen Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Kun Liu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Hong Zhu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan, China
| | - Haijun Wu
- Department of Oncology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, Hunan 410008, China
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Ghazvinian Z, Abdolahi S, Ahmadvand M, Emami AH, Muhammadnejad S, Asadzadeh Aghdaei H, Ai J, Zali MR, Seyhoun I, Verdi J, Baghaei K. Chemo-immune cell therapy by intratumoral injection of adoptive NK cells with capecitabine in gastric cancer xenograft model. BIOIMPACTS : BI 2022; 13:383-392. [PMID: 37736341 PMCID: PMC10509737 DOI: 10.34172/bi.2022.26386] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 09/23/2023]
Abstract
Introduction Gastric cancer is one of the most commonly known malignancies and is the fifth cancer-related death globally. Whereas natural killer (NK) cells play a critical role in tumor elimination; therefore, adoptive NK cell therapy has become a promising approach in cancer cytotherapy. Hence, this study investigated the chemo-immune cell therapy in MKN-45 derived xenograft gastric cancer model. Methods Three groups of animals have received the following treatments separately: activated NK cells, capecitabine, the combination of capecitabine and activated NK cells, and one was considered as the control group. Morphometric properties of tumor samples were evaluated at the end of the study. NK cells infiltration was evaluated by immunohistochemistry (IHC) of hCD56. Mitotic count and treatment response was assessed by hematoxylin and eosin (H&E) staining. The proliferation ratio to apoptosis was determined by IHC assessment of Ki67 and caspase 3. Results The results indicated that the NK cell therapy could effectively decrease the mitotic count in pathology assessment, but the tumor was not completely eradicated. In combination with metronomic chemotherapy (MC) of capecitabine, NK cell therapy demonstrated a significant difference in tumor morphometric properties compared to the control group. The proliferation ratio to apoptosis was also in line with pathology data. Conclusion Although NK cell therapy could effectively decrease the mitotic count in vivo, the obtained findings indicated lesser potency than MC despite ex vivo activation. In order to enhance NK cell therapy effectiveness, suppressive features of the tumor microenvironment and inhibitory immune checkpoints blockade should be considered.
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Affiliation(s)
- Zeinab Ghazvinian
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrokh Abdolahi
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ahmadvand
- Hematology-Oncology and Stem Cell Transplantation Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Hossein Emami
- Department of Internal Medicine, School of Medicine, Imam Khomeini Hospital Complex, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samad Muhammadnejad
- Gene Therapy Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Asadzadeh Aghdaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Jafar Ai
- Department of Tissue Engineering, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Reza Zali
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Iman Seyhoun
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Verdi
- Department of Applied Cell Sciences, School of Advanced Technologies in Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Kaveh Baghaei
- Basic and Molecular Epidemiology of Gastrointestinal Disorders Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Gastroenterology and Liver Diseases Research Center, Research Institute for Gastroenterology and Liver Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Associations of Clinical and Molecular Characteristics with the Response to Immune Checkpoint Blockade in Advanced Gastric Cancers. JOURNAL OF ONCOLOGY 2022; 2022:2162229. [PMID: 35281518 PMCID: PMC8916884 DOI: 10.1155/2022/2162229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 11/17/2022]
Abstract
Purpose Immunotherapy provides a new treatment option for advanced gastric cancer (AGC). This study aims to explore the response markers of immunotherapy in AGCs. Methods Next-generation sequencing was performed on 44 AGC patients who received immune checkpoint inhibitors and the associations between their outcomes after combination immunotherapy, and the clinicopathological/molecular characteristics were analyzed. Results The current study cohort had a median progression-free survival (PFS) of 5.9 months, an overall survival (OS) of 12.1 months, and an objective response rate (ORR) of 36.4%. Through multivariable analysis of the clinical characteristics, primary tumor resection (HR = 2.66, 95% CI: 1.06–6.70, p=0.037) and increased proportion of lymphocytes after combination immunotherapy (HR = 0.40, 95% CI: 0.16–0.99, p=0.048) were revealed as independent predictors for patient outcomes. All the 18 patients who underwent genetic profiling were microsatellite-stable with a median TMB of four mutations per Mb. ATM alterations, PI3K pathway mutations, increased TMB, and positive PD-L1 expression were associated with the increased trend of PFS and ORR. According to the combination of baseline lymphocyte count, ATM mutation, TMB status, and PD-L1 expression, patients were stratified into higher- and lower-risk groups, with the lower-risk group showing improved PFS (HR = 4.7e−10, 95% CI: 0–inf, p=0.02) and ORR (75% vs. 0%, p=0.007). Conclusion Several highly relevant potential biomarkers predictive of immunotherapy response in AGC patients have been identified in this research.
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Peng W, Zhang F, Wang Z, Li D, He Y, Ning Z, Sheng L, Wang J, Xia X, Yu C, Wang Z, Zhao Y, Liang H, Hu B, Sun C, Wang D, Cheng Y, Pan M, Xia L, Guo X, Zhang Y, Hu Z, Li X, Lu L, Zhang J, Qian H, Xie H, Sun G. Large Scale, Multicenter, Prospective Study of Apatinib in Advanced Gastric Cancer: A Real-World Study from China. Cancer Manag Res 2020; 12:6977-6985. [PMID: 32821164 PMCID: PMC7418160 DOI: 10.2147/cmar.s249153] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022] Open
Abstract
Background In China, gastric cancer (GC) ranks second in incidence and mortality. Over 80% of patients with GC were diagnosed at an advanced stage with poor clinical outcome. Chemotherapy was the mainstream treatment with limited benefit. Apatinib, an inhibitor of targeting vascular endothelial growth factor receptor 2 (VEGFR2), has been approved for third-line treatment of advanced gastric cancer. However, the data of apatinib treatment in the real-world setting are limited. In this real-world study, we aimed to understand the current treatment pattern of apatinib, investigate the effectiveness and safety of apatinib in real-world settings, and explore the potential factors associated with the clinical outcomes. Methods This was a prospective, multicenter observational study in a real-world setting. Patients aged ≥18 years with histologic diagnosis of advanced GC were eligible for enrollment. The eligible patients received either apatinib monotherapy or apatinib plus chemotherapy by physician’s discretion. Apatinib treatment could be used as first-line, second-line, or third-line and above therapy. The primary endpoint was progression-free survival (PFS). The secondary endpoints were overall survival (OS), ORR, DCR, and safety profile. Results A total of 737 patients with advanced gastric cancer treated with apatinib were included in the FAS population. A total of 54.9% patients used apatinib monotherapy and 45.1% patients used apatinib combination therapy. A total of 44.1% patients received apatinib in first-line treatment, 28.2% in second-line, and 27.7% in third-line and above. In first-line treatment, the objective response rate (ORR) was 9.09% and 16.42% in apatinib monotherapy and combination therapy groups, and disease control rate (DCR) was 78.41% and 89.29%, respectively. Patients who received combination therapy achieved significantly longer median progression-free survival (mPFS; 6.18 vs 3.52 months, p<0.01) and median overall survival (mOS; 8.72 vs 5.92 months, p<0.01) compared with monotherapy. In second-line and third-line therapy, combination therapy showed a better trend in tumor response and survival outcomes compared with monotherapy. For all patients, apatinib combined with paclitaxel were associated with longer mPFS compared with other combinations (8.88 vs 6.62 months). Multivariate analysis showed that combination with paclitaxel (p=0.02) and experience of apatinib-related specific AEs (p<0.01) were independent predictors for PFS and OS. The safety profile was tolerable and no unexpected adverse events were reported. Conclusion In a real-world setting, apatinib showed a favorable effectiveness and safety profile in patients with advanced gastric cancer. Apatinib combination therapy, especially combined with paclitaxel, might lead to better survival benefit in first-line treatment. Combination with paclitaxel and the occurrence of apatinib-specific AEs were independent factors associated with better survival outcomes. Trial Registration NCT03333967.
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Affiliation(s)
- Wanren Peng
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, People's Republic of China
| | - Fenglin Zhang
- Department of Oncology, People's Hospital of Maanshan City, Maanshan, Anhui 243000, People's Republic of China
| | - Zishu Wang
- Department of Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, People's Republic of China
| | - Dongliang Li
- Department of Gastrointestinal Surgery, People's Hospital of Lu'an City, Lu'an, Anhui 237005, People's Republic of China
| | - Yifu He
- Department of Oncology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, Anhui 230022, People's Republic of China
| | - Zhongliang Ning
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Cancer Hospital), Hefei, Anhui 230022, People's Republic of China
| | - Lili Sheng
- Department of Oncology, Yijishan Hospital of WanNan Medical College, Wuhu, Anhui 340202, People's Republic of China
| | - Jidong Wang
- Department of Oncology, The Navy Anqing Hospital, Anqing, Anhui 246003, People's Republic of China
| | - Xiaoyang Xia
- Department of Oncology, The First People's Hospital of Chuzhou City, Chuzhou, Anhui 239000, People's Republic of China
| | - Changjun Yu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, People's Republic of China
| | - Zian Wang
- Department of Oncology, The First Affiliated Hospital of Bengbu Medical College, Bengbu, Anhui 233004, People's Republic of China
| | - Yong Zhao
- Department of Oncology, People's Hospital of Lu'an City, Lu'an, Anhui 237005, People's Republic of China
| | - Hui Liang
- Department of Oncology, Lu'an Hospital of Traditional Chinese Medicine, Lu'an, Anhui 237006, People's Republic of China
| | - Bing Hu
- Department of Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, Anhui 230022, People's Republic of China
| | - Cuiling Sun
- Department of Oncology, People's Hospital of Fuyang City, Fuyang, Anhui 236047, People's Republic of China
| | - Daoqin Wang
- Department of Gastrointestinal Surgery, Wanbei Coal-Electricity Group General Hospital, Suzhou, Anhui 234000, People's Republic of China
| | - Yunsheng Cheng
- Department of Oncology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, People's Republic of China
| | - Ming Pan
- Department of Oncology, People's Hospital of Chizhou City, Chizhou, Anhui 247000, People's Republic of China
| | - Liming Xia
- Department of Oncology, The First Affiliated Hospital of Anhui University of Chinese Medicine, Hefei, Anhui 230031, People's Republic of China
| | - Xinglai Guo
- Department of Oncology, Fuyang Cancer Hospital, Fuyang, Anhui 236033, People's Republic of China
| | - Yanshun Zhang
- Department of Oncology, Huainan First People's Hospital, Huainan, Anhui 232000, People's Republic of China
| | - Zhiqiang Hu
- Department of Oncology, Huaibei Miners General Hospital, Huaibei, Anhui 235000, People's Republic of China
| | - Xinzhong Li
- Department of Oncology, People's Hospital of Huaibei, Huaibei, Anhui 235000, People's Republic of China
| | - Lin Lu
- Department of Oncology, The 901 Hospital of the Joint Logistic Support Force of the People's Liberation Army of China, Hefei, Anhui 230033, People's Republic of China
| | - Jun Zhang
- Department of Oncology, The Second People's Hospital of Wuhu, Wuhu, Anhui 241001, People's Republic of China
| | - Hong Qian
- Department of Oncology, The Navy Anqing Hospital, Anqing, Anhui 246003, People's Republic of China
| | - Hua Xie
- Department of Oncology, The People's Hospital of Xuancheng City, Xuancheng, Anhui 242000, People's Republic of China
| | - Guoping Sun
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, People's Republic of China
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X Lin J, Yoon C, Desiderio J, Yi BC, Li P, Zheng C, Parisi A, Huang CM, Strong VE, Yoon SS. Development and validation of a staging system for gastric adenocarcinoma after neoadjuvant chemotherapy and gastrectomy with D2 lymphadenectomy. Br J Surg 2019; 106:1187-1196. [PMID: 31197829 PMCID: PMC8194033 DOI: 10.1002/bjs.11181] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 01/21/2019] [Accepted: 02/25/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy is commonly used for patients with locally advanced gastric adenocarcinoma. The eighth AJCC ypTNM staging system was validated based on patients undergoing more limited lymphadenectomy (less than D2). The aim of this study was to develop a system for accurate staging of patients with locally advanced gastric adenocarcinoma who receive neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy. METHODS A modified system of ypTNM was developed, based on overall survival (OS) of patients receiving neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy at Memorial Sloan Kettering Cancer Center, and validated using data from an international cohort of patients who had similar treatment. RESULTS Of 325 patients in the derivation cohort, 33 (10·2 per cent) had ypT0 N0/+ tumours, which are not classifiable under the AJCC system. The 5-year OS rate for modified ypTNM stages I, II, IIIA and IIIB was 89, 71, 42·3 and 10 per cent respectively, compared with 82, 65·2 and 24·1 for AJCC stages I, II and III respectively. The concordance index (0·730 versus 0·709), estimated area under the curve (0·765 versus 0·740) and time-dependent receiver operating characteristic (ROC) curve throughout the observation period were all superior for modified ypTNM staging. For the validation cohort of 186 patients, the modified system was again better at separating patients into prognostic groups for OS. CONCLUSION The modified ypTNM staging system improves the accuracy of OS prediction for patients treated with neoadjuvant chemotherapy followed by gastrectomy with D2 lymphadenectomy.
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Affiliation(s)
- J. X Lin
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S
| | - C. Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S
| | - J. Desiderio
- Department of Digestive Surgery, St. Mary’s Hospital, University of Perugia, Terni, Italy
| | - B. C. Yi
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S
| | - P. Li
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - C.H. Zheng
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - A. Parisi
- Department of Digestive Surgery, St. Mary’s Hospital, University of Perugia, Terni, Italy
| | - C. M. Huang
- Department of Gastric Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - V. E. Strong
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S
| | - S. S. Yoon
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, U.S
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Liu T, Qin Y, Li J, Xu R, Xu J, Yang S, Qin S, Bai Y, Wu C, Mao Y, Wu H, Ge Y, Shen L. Pertuzumab in combination with trastuzumab and chemotherapy for Chinese patients with HER2-positive metastatic gastric or gastroesophageal junction cancer: a subpopulation analysis of the JACOB trial. Cancer Commun (Lond) 2019; 39:38. [PMID: 31234927 PMCID: PMC6591878 DOI: 10.1186/s40880-019-0384-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 06/17/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The JACOB trial (NCT01774786) was a double-blinded, placebo-controlled, randomized, multicenter, international, phase III trial evaluating the efficacy and safety of adding pertuzumab to trastuzumab and chemotherapy in first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive metastatic gastric cancer/gastroesophageal junction cancer (GEJC). The aim of this analysis was to investigate efficacy and safety outcomes in the Chinese subpopulation from the JACOB trial. METHODS This post hoc subpopulation analysis included all patients recruited in mainland China (n = 163; 20.9%) between June 2013 and January 2016. The patients were randomly assigned in a 1:1 ratio to receive pertuzumab plus trastuzumab and chemotherapy (pertuzumab group; n = 82) or placebo plus trastuzumab and chemotherapy (control group; n = 81). Intravenous pertuzumab (840 mg) and trastuzumab (8 mg/kg loading and 6 mg/kg maintenance doses) were given every 3 weeks until disease progression or unacceptable toxicity. Chemotherapy was given as per standard regimens/doses of capecitabine or 5-fluorouracil plus cisplatin. The primary endpoint was overall survival (OS); secondary efficacy endpoints included progression-free survival (PFS), and overall objective response rate (ORR). RESULTS The median OS was 18.7 months in the pertuzumab group and 16.1 months in the control group (hazard ratio [HR] 0.75; 95% confidence interval [CI] 0.49 to 1.14). The median PFS was 10.5 and 8.6 months in the pertuzumab and control groups, respectively (HR 0.85; 95% CI 0.60 to 1.21), and the median ORRs were 68.9% and 55.7%, respectively. The treatment effect in this Chinese subpopulation showed consistency with that in the global ITT population with numerically lower HR for OS and PFS compared with the control group. The safety profiles of the pertuzumab and control groups in this Chinese subpopulation analysis were generally comparable. The most common grade 3-5 adverse events were neutropenia, anemia, and leukopenia. However, due to the nature of being a post hoc subgroup analysis, the results presented here are descriptive only and need to be interpreted with caution. CONCLUSIONS OS and PFS were numerically improved by adding pertuzumab to trastuzumab and chemotherapy as first-line treatment in Chinese HER2-positive gastric cancer/GEJC patients, and this regimen demonstrated an acceptable safety profile. Trial registration ClinicalTrials.gov. NCT01774786. Registered on 24 January 2013, https://clinicaltrials.gov/ct2/show/NCT01774786.
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Affiliation(s)
- Tianshu Liu
- Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai, 200032, P. R. China
| | - Yanru Qin
- Department of Clinical Oncology, The First Affiliated Hospital, Zhengzhou University, Zhengzhou, 450052, Henan, P. R. China
| | - Jin Li
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, 200032, P. R. China.,Department of Oncology, Tongji University Eastern Hospital, Shanghai, 200120, P. R. China
| | - Ruihua Xu
- Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, 510060, Guangdong, P. R. China
| | - Jianming Xu
- Department of Oncology, 307th Hospital of PLA, Academy of Military Medical Sciences, Beijing, 100071, P. R. China
| | - Shujun Yang
- Department of Medical Oncology, Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, 450008, Henan, P. R. China
| | - Shukui Qin
- Department of Oncology, People's Liberation Army (PLA) Cancer Center, 81st Hospital of PLA, Nanjing, 210002, Jiangsu, P. R. China
| | - Yuxian Bai
- Medical Department, Harbin Medical University Cancer Hospital, Harbin, 150081, Heilongjiang, P. R. China
| | - Changping Wu
- Department of Oncology, First People's Hospital of Changzhou, Changzhou, 213003, Jiangsu, P. R. China
| | - Yixiang Mao
- Roche (China) Holding Co., Ltd., Shanghai, 201203, P. R. China
| | - Haiyan Wu
- Roche (China) Holding Co., Ltd., Shanghai, 201203, P. R. China
| | - Yilin Ge
- Medical Division, Shanghai Roche Pharmaceuticals Ltd., Shanghai, 201203, P. R. China
| | - Lin Shen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Gastrointestinal Oncology, Peking University Cancer Hospital and Institute, #52 Fucheng Road, Haidian District, Beijing, 100142, P. R. China.
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