Pattern of disease progression during third-line or later chemotherapy with nivolumab associated with poor prognosis in advanced gastric cancer: a multicenter retrospective study in Japan

Masahiko Aoki, Shigenori Kadowaki, Naoki Takahashi, Takeshi Suzuki, Kotoe Oshima, Takayuki Ando, Yoshiyuki Yamamoto, Kentaro Kawakami, Yosuke Kito, Toshihiko Matsumoto, Keitaro Shimozaki, Yasuhiro Miyazaki, Toshifumi Yamaguchi, Michitaka Nagase, Takao Tamura, Yusuke Amanuma, Taito Esaki, Yuji Miura, Kohei Akiyoshi, Eishi BabaAkitaka Makiyama, Yuji Negoro, Koji Nakashima, Naotoshi Sugimoto, Kengo Nagashima, Hirokazu Shoji, Narikazu Boku

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Accelerated tumor growth during immunotherapy in pre-existing measurable lesions, hyperprogressive disease (HPD), has been reported. However, progression of non-measurable lesions and new lesions are frequently observed in patients with advanced gastric cancer (AGC). Methods: This retrospective study involved AGC patients at 24 Japanese institutions who had measurable lesions and received nivolumab after ≥ 2 lines of chemotherapy. HPD was defined as a ≥ two-fold increase in the tumor growth rate of measurable lesions. The pattern of disease progression was classified according to new lesions in different organs and ascites appeared/increase of ascites. Results: Of 245 patients, 147 (60.0%) showed progressive disease (PD) as the best response and 41 (16.7%) showed HPD during nivolumab monotherapy. There was no significant difference in overall survival (OS) between patients with HPD and those with PD other than HPD (median OS 5.0 vs 4.8 months; hazard ratio [HR] 1.0, 95% confidence interval [CI] 0.6–1.5; p = 1.0). Fifty-three patients developed new lesions in different organs and 58 had appearance/increase of ascites; these patients showed shorter OS than those without each of these features (median OS 3.3 vs 7.1 months, HR 1.8, 95% CI 1.2–2.7, p = 0.0031 for new lesions, and 3.0 vs 7.8 months, HR 2.6, 95% CI 1.8–3.8, p < 0.0001 for ascites). Thirty-one patients who had both features showed the worst prognosis (median OS 2.6 months). Conclusions: New lesions in different organs and appearance/increase of ascites, rather than the original definition of HPD, are the patterns of disease progression associated with poor prognosis in AGC patients receiving nivolumab whose best response was PD.

Original languageEnglish
Pages (from-to)132-144
Number of pages13
JournalGastric Cancer
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 2023
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Oncology
  • Gastroenterology
  • Cancer Research

Fingerprint

Dive into the research topics of 'Pattern of disease progression during third-line or later chemotherapy with nivolumab associated with poor prognosis in advanced gastric cancer: a multicenter retrospective study in Japan'. Together they form a unique fingerprint.

Cite this