Chemotherapy for patients with advanced gastric cancer with performance status 2

We retrospectively analyzed 657 patients with advanced gastric cancer who received first-line chemotherapy. Baseline patient characteristics and treatment results were compared between Eastern Cooperative Oncology Group performance status (PS) 0-1 and PS 2 patients.

Prior to beginning first-line chemotherapy, 513, 112, and 32 patients were PS 0-1, PS 2, and PS 3-4, respectively. Patients with massive ascites (42% vs. 3%; P < .001) or inability to eat (39% vs. 4%; P < .001) were more likely to be PS 2 than PS 0-1. Significantly fewer PS 2 patients received first-line chemotherapy regimens containing oral agents (40% vs. 77%; P < .001) or combination chemotherapy (19% vs. 40%; P < .001) compared to PS 0-1 patients. Median survival time was significantly shorter in PS 2 patients (5.8 vs. 13.9 months; P < .001). Multivariate survival analysis revealed that use of oral agents was associated with a better prognosis in PS 0-1 patients (hazard ratio [HR] 0.76, 95% confidence interval [CI] 0.59-0.97, P = .03), while it was associated with poorer survival in PS 2 patients (HR 1.52, 95% CI 1.0-2.3, P = .046).

Advanced gastric cancer patients with PS 2 not only had a poorer prognosis but also differed in several baseline characteristics compared to PS 0-1 patients. These results indicate that additional clinical trials that specifically target gastric cancer patients with PS 2 may be required to evaluate optimal treatment regimens for this patient population.