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Real-world outcomes of third-line immune checkpoint inhibitors versus irinotecan-based chemotherapy in patients with advanced gastric cancer: a Korean, multicenter study (KCSG ST22-06)

 Sung Hee Lim  ;  Keun-Wook Lee  ;  Jae-Joon Kim  ;  Hyeon-Su Im  ;  In-Ho Kim  ;  Hye Sook Han  ;  Dong-Hoe Koo  ;  Jang Ho Cho  ;  Chi Hoon Maeng  ;  Min-Young Lee  ;  Hyo Jin Lee  ;  Jwa Hoon Kim  ;  Sang Gon Park  ;  Joo Young Jung  ;  Seong-Hoon Shin  ;  Ki Hyang Kim  ;  Hyeyeong Kim  ;  So Yeon Oh  ;  Minsu Kang  ;  Minkyu Jung  ;  Sun Young Rha 
 BMC CANCER, Vol.24(1) : 252, 2024-02 
Journal Title
Issue Date
Antineoplastic Combined Chemotherapy Protocols / adverse effects ; B7-H1 Antigen ; Camptothecin ; Fluorouracil ; Humans ; Immune Checkpoint Inhibitors / adverse effects ; Irinotecan ; Leucovorin ; Niacinamide / analogs & derivatives* ; Peritoneal Neoplasms* / drug therapy ; Republic of Korea / epidemiology ; Retrospective Studies ; Stomach Neoplasms* / pathology
Gastric cancer ; Irinotecan ; Nivolumab ; Pembrolizumab ; Third-line treatment
Background: Immune checkpoint inhibitor (ICI) or irinotecan-based chemotherapy is frequently used after failure of second-line paclitaxel plus ramucirumab treatment for patients with locally advanced unresectable or metastatic advanced gastric cancer (AGC). This study aimed to compare the efficacy between ICI and irinotecan-based chemotherapy as third-line treatment in patients with AGC.

Methods: We retrospectively reviewed patients with AGC, whose third-line treatment started between July 2019 and June 2021 at 17 institutions in Korea. The ICI group included patients who received nivolumab or pembrolizumab, and the irinotecan-based chemotherapy group included patients who received irinotecan or FOLFIRI (5-fluorouracil, leucovorin and irinotecan).

Results: A total of 363 patients [n = 129 (ICI) and n = 234 (irinotecan-based chemotherapy)] were analyzed. The median progression-free survival was 2.3 and 2.9 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.802). The median overall survival (OS) was 5.5 and 6.0 months in ICI and irinotecan-based chemotherapy groups, respectively (p = 0.786). For all patients included in this study, multivariable analysis showed that weight loss, peritoneal metastasis, low serum sodium or albumin, and short duration of second-line treatment were associated with inferior OS (p < 0.05). ICI showed significantly longer OS than irinotecan-based chemotherapy in patients without peritoneal metastasis. Whereas ICI showed significantly shorter OS in patients without PD-L1 expression than irinotecan-based chemotherapy.

Conclusions: No significant difference in survival outcome was observed between ICI and irinotecan-based chemotherapy as third-line treatment for AGC patients. ICI might be preferred for patients without peritoneal metastasis and irinotecan-based chemotherapy for patients with tumors without PD-L1 expression.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Rha, Sun Young(라선영) ORCID logo https://orcid.org/0000-0002-2512-4531
Jung, Min Kyu(정민규) ORCID logo https://orcid.org/0000-0001-8281-3387
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