Second-line treatment efficacy and toxicity in older vs. non-older patients with advanced gastric cancer: A multicentre real-world study

Objectives: Although gastric cancer (GC) incidence riseswith age, older patients are poorly represented in clinical trials, whose results are therefore difficult to translate into standard management of older patients. Purpose of this study was to compare clinico-pathological features and survival outcomes between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Materials andMethods: Clinico-pathological characteristics, basal values, and treatment data of older (≥70 years at second-line start) and non-older patients were compared using chi-square test or 2-tailed Fisher exact test. The Kaplan-Meier estimation was used to calculate progression-free survival (PFS) and overall survival (OS), which were examined by log-rank test. Results: Older patients represented 31.8% of the population (N=868). Intestinal typewasmore frequent in older patients (P=.02). Poorly differentiated tumoursweremore often observed in non-older patients (P=.009). At stage IV diagnosis, the rate of livermetastaseswas higher in older patients (P=.02),while peritoneal spreadwas more represented in non-older patients (P=.002). Although older patientswere more often treatedwith monotherapy (P=.001), they had similar PFS (HR 0.86, 95%CI 0.71–1.03, P=.102) and OS (HR 0.82, 95%CI 0.65–1.02, P = .08) compared to the non-older counterpart. No statistical differences were observed in treatment-related adverse events, hospital admissions, or further treatment lines between age groups. Conclusion: In our large cohort study, despite some differences in tumour characteristics and treatment intensity, no survival difference was found between older and non-older patients with advanced GC treated with at least two chemotherapy lines. Incidence of adverse events was similar between age groups.