Depth of response is a significant predictor for long-term outcome in advanced gastric cancer patients treated with trastuzumab
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Choong-Kun Lee1, Seung-Seob Kim2, Saemi Park3, Chan Kim1, Su Jin Heo1, Joon Seok Lim2, Hyunki Kim4, Hyo Song Kim1, Sun Young Rha1, Hyun Cheol Chung1, Sohee Park3, Minkyu Jung1
1Division of Medical Oncology, Department of Internal Medicine, Yonsei Cancer Center, Yonsei University, College of Medicine, Seoul, Korea
2Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
3Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Korea
4Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
Sohee Park, email: [email protected]
Minkyu Jung, email: [email protected]
Keywords: gastric cancer, trastuzumab, depth of response, early tumor shrinkage, survival
Received: December 14, 2016 Accepted: March 01, 2017 Published: March 10, 2017
Purpose: We aimed to determine and compare the predictive values of depth of response (DpR) and early tumor shrinkage (ETS) on long-term outcomes in gastric cancer patients treated with trastuzumab.
Results: From a total of 368 computed tomography examinations, DpR and ETS were evaluated. DpR was a significant tumor-size metric in predicting PFS and OS, and showed better discriminatory ability (higher Cτ indices, 0.6957 for PFS; 0.7191 for OS) than ETS. DpR ≥ 45% (vs. < 45%) was the optimal cutoff value, as it was best able to identify patients with longer PFS (median 9.0 vs. 6.3 months, hazard ratio [HR] = 0.608; 95% confidence interval [CI]: 0.335 to 1.104; P = 0.102) and OS (median 23.5 vs. 13.1 months, HR = 0.441; 95% CI: 0.203 to 0.955; P = 0.038).
Materials and Methods: Sixty-one gastric cancer patients who received first-line trastuzumab-based chemotherapy were assessed for DpR and ETS. We employed Kaplan-Meier estimates, log-rank tests, Cox proportional hazards regression models, time-dependent receiver operating characteristics, and Youden’s J index to evaluate and determine cutoff values of DpR and ETS as predictors of progression-free survival (PFS) and overall survival (OS).
Conclusions: DpR and ETS were significant predictors of long-term outcomes in gastric cancer patients treated with first-line trastuzumab. Validation in prospective trials with larger patient populations is needed.
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