Impact of the number of therapy lines on survival in advanced gastric and esophagogastric adenocarcinoma - a real-world retrospective analysis from Croatia.

The aim of the study was to conduct a retrospective database analysis to understand the current treatment patterns and outcomes to plan potential improvements in therapy delivery and patient selection. The electronic patient medical records of 225 patients with advanced gastric and esophagogastric adenocarcinoma treated at two Croatian high-volume tertiary centers from January 2018 to December 2021 were analyzed. Patients ineligible for chemotherapy (66 of 291, 22.7%) due to poor general condition or co-morbidities were not included in the study. The median overall survival (OS) for the whole cohort was 11.0 months (95% confidence interval (CI) 9.7-12.0). Of the 225 patients who received first-line therapy, 47.6%, 16.9%, and 3.1% received second-, third-, and fourth-line therapy, respectively. Survival correlated significantly with the number of treatment lines received (p<0.001), with a median OS from diagnosis of 7.8 (95% CI 6.6-9.4), 12.0 (95% CI 10.0-14.0), and 20.0 months (95% CI 18.0-23.0) for patients receiving 1, 2, and ≥3 lines of treatment, respectively. This study confirmed the positive impact of the number of chemotherapy lines on OS. This highlights the importance of the ratio of patients receiving multiple lines of therapy as well as the availability of new and effective drugs in real-life clinical practice. The selection of optimal therapy for each patient in the first-line therapy is important because a significant number of patients do not receive second-line therapy.

Predictors of outcome in elderly patients with metastatic colorectal cancer: the final results of a prospective phase II study of bevacizumab in combination with capecitabine as first-line treatment.

In 2011, we demonstrated that bevacizumab in combination with capecitabine as first-line treatment is effective in elderly patients with metastatic colorectal cancer (mCRC). We present the final results of the study with data on tumor molecular biology, sidedness and postprogression therapy. Forty patients with mCRC aged ≥70 years, initially treated with bevacizumab and capecitabine, were followed from the start of the treatment of metastatic disease to death. Tumor tissue samples were retrospectively analyzed for RAS, BRAF and microsatellite status. After a median follow-up time of 20.5 months, the median progression-free survival (PFS) and overall survival (OS) were 9.8 and 20.5 months, respectively and the objective response rate (ORR) was 65%. Twelve patients had mutation in RAS and four patients in BRAF gene, which coexisted with MSI in two cases. Patients with the right-sided tumor had apparently, but not statistically significantly lower PFS (8.6 vs. 13 months, P = 0.14) and statistically significantly lower OS (13 vs. 23.1 months, P = 0.046). Twelve patients with one or more postprogression therapy lines had significantly better ORR (12/12 = 100% vs. 14/28 = 50%, P = 0.003), median PFS (17.2 vs. 8.5 months, P < 0.001) and median OS (42 vs. 13 months, P < 0.001) than patients who received just first-line study treatment. Elderly patients with mCRC responded favorably to bevacizumab and capecitabine, especially the subgroup with the left-sided primary tumor. In the further subset of this group, characterized by RAS/BRAF wild-type and MSS tumors, the application of postprogression therapies was feasible and resulted in significant prolongation of survival.

The role of the multidisciplinary team in the decision making process in stage one testicular cancer - retrospective cohort analysis.

PURPOSE: To analyze the role of a multidisciplinary team (MDT) in the decision-making process in clinical stage one (CS I) testicular cancer (TC). METHODS: We retrospectively evaluated data on 115 consecutive patients with CS I TC (excluding stage IS) who were referred to the Department of Oncology, University Hospital of Split, Croatia, from 2003 to 2012. Fifty-six patients (48.7%) were referred between 2003 and 2007, before the introduction of the MDT and 59 patients (51.3%) between 2008 and 2012, after the introduction of the MDT. We evaluated the overall treatment outcome (cure rate) and the total number of patients with CS I TC who were treated or monitored: in seminoma (SA) group adjuvant radiotherapy (ART) vs adjuvant chemotherapy (ACT) or active surveillance (AS) and in non-seminoma (NSA) group retroperitoneal lymphadenectomy (RPLND) vs ACT or AS. RESULTS: After the introduction of the MDT we stopped using ART for CS I SA, and significantly increased the usage of ACT and AS (p<0.001). RPLND in CS I NSA was used significantly less often after the introduction of the MDT while the usage of ACT and AS increased (p=0.047). CONCLUSION: With the MDT introduction we significantly changed the approach to patients with CS I TC. More aggressive and more toxic forms of the postoperative treatment were replaced by AS or less toxic ACT. Despite less aggressive adjuvant treatment approach, significant changes in the cure rate between two time periods were not noticed.