What is the longest survival rate for stage 4 gastric cancer?

Longest Survival in Stage 4 Gastric Cancer

For stage 4 gastric cancer, the longest reported median survival is approximately 13.8 months, achieved with trastuzumab added to platinum-fluoropyrimidine chemotherapy in HER2-positive patients. 1

Survival Benchmarks by Treatment Approach

Chemotherapy Alone (Standard Palliative Care)

• Median survival: 7-11 months with combination chemotherapy regimens 1
• Best supportive care alone yields only 3-5 months median survival 1
• Single-agent chemotherapy provides inferior outcomes compared to combination regimens 2

HER2-Targeted Therapy (Best Outcomes)

• Trastuzumab plus cisplatin/fluoropyrimidine: 13.8 months median survival (versus 11.1 months without trastuzumab) 1
• This represents the highest survival reported in guidelines for stage 4 disease
• Only applicable to HER2-positive tumors (approximately 20% of gastric cancers)

Palliative Surgery Plus Chemotherapy (Selected Patients)

• Median survival: 9.1-16.3 months when palliative gastrectomy is combined with systemic chemotherapy 3, 4
• Surgery alone without chemotherapy shows no survival benefit 5
• The REGATTA trial showed no benefit from gastrectomy plus chemotherapy versus chemotherapy alone in Asian patients (25.1% versus 31.7% 2-year survival) 1

Key Prognostic Factors Affecting Survival

Favorable factors that extend survival include: 2

• Combination chemotherapy (versus single agent)
• Absence of liver metastases
• Absence of peritoneal metastases
• Good performance status (KPS ≥60 or ECOG ≤2)
• No significant weight loss (<5%)
• Normal LDH levels

Unfavorable factors that shorten survival: 2

• Histological grade III tumors
• Hepatic metastases (HR 1.6)
• Peritoneal metastases (HR 1.33)
• Weight loss >5% (HR 1.96)
• Need for blood transfusions (HR 1.58)

Recommended First-Line Regimens

For HER2-positive disease: 1

• Trastuzumab + cisplatin + fluoropyrimidine (5-FU or capecitabine)
• Response rate: 47.3% versus 34.5% without trastuzumab

For HER2-negative disease: 1

• ECF/ECX/EOX (epirubicin, cisplatin/oxaliplatin, 5-FU/capecitabine)
• DCF (docetaxel, cisplatin, 5-FU) - FDA approved but more toxic 1
• FOLFOX or irinotecan-based regimens as alternatives 1

Performance Status Thresholds

Chemotherapy candidates: 1

• KPS ≥60 or ECOG PS ≤2
• These patients should receive combination chemotherapy plus best supportive care

Best supportive care only: 1

• KPS <60 or ECOG PS ≥3
• Chemotherapy unlikely to provide benefit and may worsen quality of life

Critical Caveats

• The 2-year survival rate for stage 4 gastric cancer remains poor at approximately 25-31% even with optimal treatment 1
• Palliative gastrectomy carries 8.7% mortality and 33.3% morbidity and should only be considered in highly selected patients with good performance status who can subsequently receive chemotherapy 4
• Endoscopic stenting provides rapid symptom relief with 0% mortality but does not improve overall survival 5
• Second-line chemotherapy options exist (irinotecan, taxanes) but have limited data supporting survival benefit 1