Is there a preferred platinum and fluoropyrimidine regimen for advanced HER2-negative esophagogastric adenocarcinoma? Insights from 1293 patients in AGAMENON-SEOM registry.

BACKGROUND: The optimal chemotherapy backbone for HER2-negative advanced esophagogastric cancer, either in combination with targeted therapies or as a comparator in clinical trials, is uncertain. The subtle yet crucial differences in platinum-based regimens' safety and synergy with combination treatments need consideration. METHODS: We analyzed cases from the AGAMENON-SEOM Spanish registry of HER2-negative advanced esophagogastric adenocarcinoma treated with platinum and fluoropyrimidine from 2008 to 2021. This study focused exclusively on patients receiving one of the four regimens: FOLFOX (5-FU and oxaliplatin), CAPOX (capecitabine and oxaliplatin), CP (capecitabine and cisplatin) and FP (5-FU and cisplatin). The aim was to determine the most effective and tolerable platinum and fluoropyrimidine-based chemotherapy regimen and to identify any prognostic factors. RESULTS: Among 1293 patients, 36% received either FOLFOX (n = 468) or CAPOX (n = 466), 20% CP (n = 252), and 8% FP (n = 107). FOLFOX significantly increased PFS (progression free survival) compared to CP, with a hazard ratio of 0.73 (95% CI 0.58-0.92, p = 0.009). The duration of treatment was similar across all groups. Survival outcomes among regimens were similar, but analysis revealed worse ECOG-PS (Eastern Cooperative Oncology Group-Performance Status), > 2 metastatic sites, bone metastases, hypoalbuminemia, higher NLR (neutrophil-to-lymphocyte ratio), and CP regimen as predictors of poor PFS. Fatigue was common in all treatments, with the highest incidence in FOLFOX (77%), followed by FP (72%), CAPOX (68%), and CP (60%). Other notable toxicities included neuropathy (FOLFOX 69%, CAPOX 62%), neutropenia (FOLFOX 52%, FP 55%), hand-foot syndrome in CP (46%), and thromboembolic events (FP 12%, CP 11%). CONCLUSIONS: FOLFOX shown better PFS than CP. Adverse effects varied: neuropathy was more common with oxaliplatin, while thromboembolism was more frequent with cisplatin.

Efficacy and safety of chemotherapy in young patients with advanced gastroesophageal adenocarcinoma: data from the Spanish AGAMENON-SEOM registry.

BACKGROUND: Gastroesophageal adenocarcinoma in young adults (GCYA) counts for 10-15% of diagnoses. Previous studies have mainly focused on surgical outcomes in patients with resectable tumors; however, systemic therapy for advanced GCYA remains under-evaluated. This study aims to assess the efficacy-related outcomes and safety of first-line chemotherapy (CT) in younger versus older patients with advanced gastroesophageal adenocarcinoma. METHODS: Patients with advanced gastroesophageal adenocarcinoma from the AGAMENON-SEOM registry treated with first-line polychemotherapy between January 2008 and October 2022 were included. We compared clinicopathological features, therapies received, efficacy-related outcomes, and toxicity between individuals aged < and ≥ 45 years. RESULTS: Out of 3386 patients, 263 (7.8%) were < 45 years. Young patients exhibited a higher proportion of females affected, lower ECOG-PS ≥ 2, fewer comorbidities, and more aggressive disease-related features, such as higher proportion of diffuse subtype, signet-ring cells, plastic linitis, grade 3, peritoneal metastases and metastatic disease at diagnosis. They received more triple-agent combinations and underwent more surgeries in metastatic setting. No significant differences were observed between groups in overall response rate (53.1% vs. 52.3% in < and ≥ 45 years, respectively, p = 0.579), progression-free survival (6.1 vs. 6.83 months, p = 0.158) and overall survival (11.07 vs. 10.81 months, p = 0.82), even after adjusting for potential confounding factors. Grade 3-4 adverse events were comparable in both groups, although toxicity leading to treatment discontinuation was more frequent in older patients. CONCLUSIONS: In the AGAMENON-SEOM registry, younger patients with GCYA exhibited more aggressive clinicopathological features, and despite receiving more aggressive treatments, similar efficacy outcomes and toxicity profiles were achieved compared to their older counterparts. In the AGAMENON-SEOM registry, GEAC in < 45 years showed more aggressive clinicopathological features and, although treated with more intense first-line CT regimens, similar efficacy outcomes and toxicity were achieved compared to older patients.

Humanización en la comunicación de malas noticias en el paciente oncológico y paliativo / Humanization in the communication of bad news in cancer and palliative patients

La comunicación de malas noticias, si bien supone un momento de importante vulnerabilidad para el paciente y sus allegados, es un acto necesario para una atención de calidad. Se trata de una habilidad transversal que, sin embargo, suele carecer de una formación específica en las facultades de Medici-na. Existen numerosos protocolos que establecen las bases de una comunicación eficiente. No obs-tante, lo que marca la diferencia en términos de humanidad es el toque personal que cada médico ofrece. En este artículo ofrecemos una reflexión sobre la visión predominante en el Servicio de Onco-logía Médica de Fuenlabrada del proceso de comunicación de malas noticias. Exponemos conceptos metafísicos, psicológicos y sociales sobre los cuales impera la necesidad de reflexionar para, desde una compresión profunda de la dificultad que la comunicación de malas noticias entraña, ser capa-ces de mejorar. Así mismo, sugerimos elementos fácilmente incorporables a la práctica clínica diaria.

Although the communication of bad news is a moment of great vulnerability for the patient and his or her relatives, it is necessary for quality care. However, it is a cross-cutting skill that often needs more specific training in medical schools. Numerous protocols lay the groundwork for efficient communication. However, each physician's personal touch makes a difference in terms of humanity. In this article, we reflect on the predominant vision of communicating bad news in the Medical On-cology Service of Fuenlabrada. We expose metaphysical, psychological, and social concepts on which there is a need to reflect to be able to improve from a deep understanding of the difficulty that the communication of bad news entails. Finally, we suggest elements that can be easily incorporated into daily clinical practice.

[Gastric cancer in a Spanish hospital: Segovia General Hospital (2005-2008)]. / Cáncer gástrico en un hospital español: Hospital General de Segovia (2005-2008).

OBJECTIVE: To estimate the incidence, pathological characteristics, treatment patterns, survival and mortality of gastric cancer in Segovia from 2005-2008. METHODS: We conducted a retrospective, descriptive study of 163 patients diagnosed with gastric cancer at the Segovia General Hospital during the study period. RESULTS: We estimated a gastric cancer incidence of 25 cases/100,000 inhabitants. The ratio of men to women was 1.6:1. The mean age was 72 years. The most important findings were diagnosis in stages III and IV (64.5%), the high frequency of intestinal carcinoma (56.4%) and the gastric antrum as the most frequent localization (48.8%). At the end of the study, 54.2% of patients had died and the median overall survival was 19 months. The main factors for an unfavorable prognosis were advanced tumoral stage (III and IV), the number of nodes involved, and diffuse histological type. Despite surgical treatment with curative intent, 63.2% of tumors at early stages (I and II) recurred during the study. CONCLUSIONS: The risk of gastric cancer in Segovia is higher in men aged over 70 years. Most tumors are diagnosed at advanced stages and recurrences are common, limiting the possibility of cure. Early diagnosis of this entity and improved treatments are required.