B34Weekly cisplatin, leucovorin and 5Fluorouracile (PFL) as first line chemotherapy in selected patients with advanced gastric cancer

Background: gastric cancer is very often diagnosed in advanced stage, in elderly patients and with a poor performance status due to tumour aggressiveness. In this cases it is difficult to administer standard first line chemotherapy, and it is necessary a dose reduction and personalization of chemotherapy. Aim of the study: we retrospectively reviewed data from 157 patient with gastric cancer observed from January 2012 to November 2015 and treated at Oncology Unit of Humanitas Gavazzeni. We observed 23 patients treated with weekly platinum and 5FU based chemotherapy (PFL) first line CT due to their clinical conditions, age and comorbidities. Results: 23/70 patients treated with first line chemotherapy received weekly platinumm leucovorin and 5FU chemotherapy; 3 of them in combination with trastuzumab. Median age was 67.5 years (range 37.1-77.5), gender F/M 8/15. ECOG performance status was 0/1/2 in 8/10/5 cases. The median number cycles of PFL was 8 (range 1-16). Best response to PFL was RP/SD/PD/not evaluable in 7 (30%)/8/7/1, with an DCR of 65%. Median PFS was 5.25 months (range 0.4-18.5) and median OS was 7.93 months (range 0.4-40.2). Grade 3-4 hematological toxicity (neutropenia and thrombocytopenia) was observed in 5 pts (21.7%),grade 2 hematological toxicity was observed in 11 pts (47.8%), grade 2 asthenia and mucositis in 5 pts (21.7%), mild nausea and mucositis (G1) was observed in 4 pts (17%). Dose reduction and delay was necessary (due to observed hematological toxicity) in 7 pts (30%). Seventeen patients experienced progressive disease, and 6 of them had a second line chemotherapy (35%). Conclusion: even with the limits derived from retrospective analysis of a small sample size (23 pts), weekly PFL demonstrated to be a safe and effective treatment for patients with advanced gastric cancer whose age, clinical conditions, and comorbidites contraindicate standard treatment due to high risk of toxicity.