From the Guidelines
The five-year survival rate for patients with metastatic gastric carcinoma treated with oral Xeloda (capecitabine) alone is generally poor, approximately 5-10%. Xeloda is typically not used as a single agent for metastatic gastric cancer but rather as part of combination chemotherapy regimens. The standard approach for metastatic gastric cancer usually involves combination therapies such as XELOX (Xeloda plus oxaliplatin) or ECX (epirubicin, cisplatin, and Xeloda).
Key Points to Consider
- These combination regimens can improve median survival to 9-13 months, but the five-year survival remains low.
- Factors affecting survival include the patient's performance status, extent of metastatic disease, HER2 status, and response to initial therapy.
- For HER2-positive tumors, adding trastuzumab to chemotherapy can improve outcomes, as seen in studies such as 1.
- The poor long-term survival reflects the aggressive nature of metastatic gastric cancer and the limited effectiveness of current systemic therapies in achieving durable disease control.
Evidence-Based Recommendations
- Patients should discuss their individual prognosis with their oncologist, as personal factors can significantly influence outcomes.
- The use of capecitabine in combination with other agents, such as oxaliplatin, has shown promise in improving survival rates, as demonstrated in studies like 1 and 1.
- The choice of treatment regimen should be based on the individual patient's needs and characteristics, taking into account factors such as performance status, extent of disease, and HER2 status.
Important Considerations
- The REAL 2 trial, referenced in 1, compared capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced esophagogastric cancer, and found that capecitabine and oxaliplatin were as effective as fluorouracil and cisplatin, respectively.
- The ML 17032 trial, also referenced in 1, evaluated the combination of capecitabine and cisplatin versus the combination of fluorouracil and cisplatin as first-line treatment in patients with previously untreated advanced gastric cancer, and found that the capecitabine and cisplatin regimen had a superior overall response rate and overall survival.
From the Research
Metastatic Gastric Carcinoma Treatment with Oral Xeloda
- The provided studies do not directly address the five-year survivor rate for metastatic gastric carcinoma patients treated with oral Xeloda.
- However, the studies discuss various treatment options for advanced gastric cancer, including ramucirumab plus paclitaxel as second-line therapy 2, 3, 4.
- One study reports a case of a patient with extensively metastatic HER2-positive gastric carcinoma who achieved complete remission after treatment with the FLOT regimen and Trastuzumab, with a five-year survival rate 5.
- Another study discusses the PADDLE trial, which investigates the efficacy of nab-paclitaxel plus ramucirumab in combination with nivolumab as second-line treatment for unresectable advanced or recurrent gastric cancer 6.
Survival Rates
- A study analyzing the efficacy and safety of second-line ramucirumab plus paclitaxel in AGC patients refractory to nivolumab plus chemotherapy reports a median overall survival of 6.3 months 3.
- A nationwide real-world outcomes study in Korea reports a median overall survival of 10.03 months for patients with advanced gastric or GEJ adenocarcinoma treated with ramucirumab plus paclitaxel as second-line treatment 4.
- However, these studies do not provide information on the five-year survivor rate for metastatic gastric carcinoma patients treated with oral Xeloda.
Treatment Options
- The studies suggest that various treatment options are available for advanced gastric cancer, including ramucirumab plus paclitaxel, the FLOT regimen, and Trastuzumab 2, 5, 3, 4.
- However, the efficacy and safety of these treatment options may vary depending on individual patient characteristics and disease progression.