Comparison of oral capecitabine alone versus platinum combinations in elderly metastatic gastric cancer patients

Abstract

Objective: Gastric cancer is responsible for a considerable proportion of all cancer-related deaths. Elderly cancerpatients are often ignored in prospective studies in which the efficacy of chemotherapy is evaluated, although morethan half of all gastric cancer cases are over the age of 70 years. The present study aims to evaluate the efficacy andfeasibility of capecitabine-based chemotherapies in geriatric patients with gastric cancer.Method: A total of 81 patients over the age of 65 years who received chemotherapy for metastatic gastric cancer attwo oncology centers between 2012 and 2017 were included in the study. The medical records of the patients wereevaluated retrospectively, and the patients and their performance status were evaluated using the American JointCommittee on Cancer staging system and the World Health Organisation scale, respectively.Results: The mean age was 74 years. The male gender and the adenocarcinoma histological type were seen in higherrates. Most of the patients underwent capecitabine-cisplatin chemotherapy, and the mean follow-up was 42 months.The median overall survival of the groups of patients receiving capecitabine-cisplatin, capecitabine-oxaliplatin andcapecitabine was 8 months, 10.7 months and 8.9 months, respectively, indicating no statistically significantdifferences between the groups (p=0.467). The median overall survival of all patients was found to be 8.7 months. Theprogression-free survival between the different chemotherapy subgroups was not statistically significant (p=0.59).The most common side effect was found to be anemia. Grade 3–4 adverse effects were similar between the arms of thestudy (p=0.725). A statistically significant increase was found in the mortality risk with an increased number ofmetastatic sites in a multivariate analysis (p=0.001). No correlation was found between the chemotherapy protocolsand mortality risk (p=0.472). Adverse effects such as stomatitis, nausea/vomiting, neuropathy, neutropenic fever andnephrotoxicity, independent of chemotherapy, were statistically and significantly associated with the mortality risk(p=0.045, p=0.047, p=0.036, p=0.02 and p=0.049, respectively). Conclusions: Our study results show that adverse effects such as stomatitis, nausea/vomiting, neutropenic fever,nephrotoxicity and neuropathy increase the mortality risk which suggest that particularly oral health care, theapplication of appropriate antiemetic treatments, the close follow-up of kidney function tests and adequate hydration,protective infection barrier measures and effective treatment of neuropathy associated with chronic diseases are asimportant as chemotherapy in geriatric cases.