Oral intake of advanced gastric cancer patients worsens in later-line chemotherapy

Later-line chemotherapy does not seem to improve oral intake in patients with advanced gastric cancer (AGC), which is why careful adaptation of regimens is necessary for those at risk for impaired oral intake, suggests a recent study.

To determine the oral intake status of patients with AGC during later-line chemotherapy, the authors retrospectively analysed data of those who experienced disease progression during first-line chemotherapy administered from January 2012 to December 2018 in a single institution.

Insufficient oral intake was defined as requiring daily intravenous fluids or hyperalimentation. Oral intake-related factors were identified through multivariate logistic regression.

A total of 589 patients were included. Of these, 461 (78.3 percent), 314 (53.3 percent), and 179 (30.4 percent) had sufficient oral intake at disease progression during first-, second-, and third-line chemotherapy, respectively. Some 131 patients (22.2 percent) initiated fourth-line chemotherapy, of whom 118 (20.0 percent) showed sufficient oral intake.

Eleven of 67 (16 percent) patients and two of 39 (5 percent) had improved oral intake during second- and third-line chemotherapy, respectively, while 85 of 428 (19.9 percent) and 70 of 259 (27.0 percent) showed deterioration in oral intake.

The following factors contributed to deterioration in oral intake during second-line chemotherapy: poor Eastern Cooperative Oncology Group Performance Status (odds ratio [OR], 4.32; p<0.001), moderate or severe ascites (OR, 1.96; p=0.045), peritoneal metastasis (OR, 2.12; p=0.029), prior palliative surgery (OR, 3.41; p=0.003), and high neutrophil-to-lymphocyte ratio (OR, 3.09; p<0.001).

Additionally, poorly differentiated pathology (OR, 2.52; p=0.025) and high neutrophil-to-lymphocyte ratio (OR, 2.65; p=0.006) were associated with deterioration in oral intake during third-line chemotherapy.

“Insufficient oral intake in AGC limits the use of several drugs,” the authors noted.