Nanoparticle albumin-bound paclitaxel and ramucirumab versus paclitaxel and ramucirumab as second-line chemotherapy for unresectable advanced or recurrent gastric cancer: a multicenter, propensity score-matched analysis (CROSS SELL study)

• Published in: International journal of clinical oncology Vol. 27; no. 4; pp. 684 - 694
• Main Authors: Nakasya, Akio, Hagiwara, Yuya, Ikoma, Tatsuki, Kurioka, Yusuke, Matsumoto, Toshihiko, Yamamoto, Yoshiyuki, Tsuduki, Takao, Kajiwara, Takeshi, Moriwaki, Toshikazu, Nishina, Tomohiro, Yamashita, Natsumi, Hyodo, Ichinosuke
• Format: Journal Article
• Language: English
• Published: Singapore Springer Singapore 01-04-2022; Springer Nature B.V
• Subjects: Albumin; Albumin-Bound Paclitaxel - therapeutic use; Antibodies, Monoclonal, Humanized; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer Research; Chemotherapy; Gastric cancer; Humans; Immunotherapy; Medicine; Medicine & Public Health; Monoclonal antibodies; Nanoparticles; Neoplasm Recurrence, Local - etiology; Neutropenia; Oncology; Original; Original Article; Paclitaxel; Patients; Propensity Score; Ramucirumab; Retrospective Studies; Stomach Neoplasms - drug therapy; Surgical Oncology; Survival; Targeted cancer therapy; Toxicity; Treatment Outcome; Chemotherapy; Ramucirumab; Propensity score; Albumin-bound paclitaxel; Gastric cancer; Paclitaxel
• ISSN: 1341-9625; 1437-7772; 1437-7772
• DOI: 10.1007/s10147-022-02114-y

Background
Paclitaxel plus ramucirumab (PTX + RAM) is the standard second-line chemotherapy for unresectable advanced or recurrent gastric cancer (AGC). Nanoparticle albumin-bound paclitaxel (nab-PTX) is an improved, more convenient form of PTX and is non-inferior to PTX. Although some retrospective and single-arm phase II studies regarding nab-PTX + RAM have been reported, comparative studies are lacking. Here, we compared the efficacy and toxicity of nab-PTX + RAM and PTX + RAM using propensity score matching.
Methods
Clinical data of 265 patients treated for AGC with nab-PTX + RAM or PTX + RAM were retrospectively collected. Nab-PTX was administered at dosages of 100 mg/m
2
, replacing PTX in the standard PTX + RAM regimen. Progression-free survival (PFS), overall survival (OS), and toxicity were compared using 1:1 propensity score matching.
Results
In total, 190 (72%) patients were matched. The median PFS was 5.3 [95% confidence interval (CI) 4.4–6.3] and 4.7 (95% CI 3.2–5.3) months in the nab-PTX + RAM and PTX + RAM groups, respectively [hazard ratio (HR) = 0.76, 95% CI 0.56–1.03,
p
 = 0.07]. The median OS was 11.5 (95% CI 9.2–15.0) and 9.9 (95% CI 8.0–12.7) months, respectively (HR = 0.78, 95% CI 0.56–1.07,
p
 = 0.12). Grade 3 and 4 neutropenia was observed more frequently in the nab-PTX + RAM group (72% vs. 56%,
p
 = 0.03). No treatment-related deaths occurred.
Conclusions
Nab-PTX + RAM exhibited more favorable trends in terms of PFS and OS but was more myelosuppressive than PTX + RAM. As neutropenia is commonly manageable toxicity, nab-PTX + RAM presents a treatment alternative for AGC. Further studies including randomized, controlled studies are warranted.