Treatment of patients with advanced gastric cancer: experience from an Indian tertiary cancer center

Majority of patients in developing countries diagnosed with gastric cancer have an advanced stage at presentation with overall poor performance status. The aim of the study was to assess outcomes of first- and second-line chemotherapy and determine prognostic factors among patients with advanced gastric cancer (AGC). Using a prospectively maintained database, we identified 144 patients with AGC treated at Tata Memorial Centre between January 2012 and September 2013. Sixteen patients received best supportive care, and 128 patients received palliative chemotherapy. Cox regression was used for multivariate analysis of survival. Of 128 patients, 42(33 %) received Cape-Ox, 22(17.1 %) EOX and 47(36.7 %) DOX while rest received other regimens. PS was 2 in 36 (28 %) patients at presentation, and 97 % of patients had ≥3 sites of metastasis. Forty-eight patients (37.5 %) had signet ring histology. Median follow-up was 9 months. Median progression-free survival/overall survival (OS) was 6/8 months, respectively. Of 93 patients who progressed 39 (41.9 %) patients received second-line chemotherapy. Multivariate analysis for OS showed that PS and use of taxane in first-line setting were significant prognostic factors. Patients who received second-line therapy had longer survival than those who did not (12 vs. 6 months; P = 0.002). The overall outcome of our patients is comparable to the Western reported data despite an advanced disease at presentation.