Revalidation of the ATTRACTION-4 study in a real-world setting: a multicenter, retrospective propensity score matching study in China

Yuhong Dai; Yongqing Liu; Zhimin Gong; Lilin He; Lei Wang; Wenjie Yang; Ping Qiu; Fangyuan Zhang; Xianglin Yuan; Henghui Cheng; Hong Qiu

doi:10.3389/fimmu.2023.1264929

Revalidation of the ATTRACTION-4 study in a real-world setting: a multicenter, retrospective propensity score matching study in China

Front Immunol. 2023 Sep 15:14:1264929. doi: 10.3389/fimmu.2023.1264929. eCollection 2023.

Authors

Yuhong Dai¹, Yongqing Liu¹, Zhimin Gong², Lilin He³, Lei Wang², Wenjie Yang³, Ping Qiu⁴, Fangyuan Zhang¹, Xianglin Yuan¹, Henghui Cheng⁵, Hong Qiu¹

Affiliations

¹ Department of Oncology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China.
² Department of Oncology, Xiangyang Central Hospital, Affiliated Hospital of Hubei University of Arts and Science. Institute of Oncology, Hubei University of Arts and Science, Xiangyang, Hubei, China.
³ Department of Oncology, The First People's Hospital of Tianmen, Tianmen, Hubei, China.
⁴ Department of Oncology, Jingzhou Central Hospital, Jingzhou, Hubei, China.
⁵ Institution of Pathology, Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei, China.

Abstract

Background: Immune-checkpoint inhibitors (ICIs) combined with chemotherapy have been successfully used in clinical trials to treat advanced gastric cancer. However, the efficacy and safety of first-line immunotherapy combined with chemotherapy in Chinese patients are unknown.

Methods: This multicenter retrospective study included patients with human epidermal growth factor receptor-2 (HER-2) negative advanced gastric cancer treated with first-line chemotherapy or chemotherapy with an ICI between January 2019 and December 2022. Propensity score matching was used to compare progression-free survival (PFS), overall survival, objective response rates, and adverse reactions between cohorts.

Results: After propensity score matching, 138 patients, who had balanced baseline characteristics, were included in the chemotherapy and combination treatment groups. The median follow-up duration was 16.90 months, and the median PFS was 8.53 months (95% confidence interval [CI] 7.77-9.28) in the combination treatment group and 5.97 months (95% CI 4.56-7.37) in the chemotherapy group. The median survival duration was 17.05 months (95% CI 14.18-19.92) in the combination treatment group and 16.46 months (95% CI 12.99-19.93) in the chemotherapy group. The PFS subgroup analysis revealed that age ≥65 years, women, Eastern Cooperative Oncology Group performance status of 1, non-signet ring cell carcinoma, esophagogastric junction, liver metastasis, peritoneal metastasis, no massive ascites, only one metastatic organ, and combined platinum-based chemotherapy correlated with treatment benefit. The incidences of adverse events above grade 3 were comparable between groups.

Conclusions: Our study confirmed the ATTRACTION-4 trial results. Compared with chemotherapy, first-line ICIs combined with chemotherapy prolonged PFS but did not improve overall survival in patients with HER-2-negative advanced gastric cancer.

Keywords: advanced gastric cancer; immune checkpoint inhibitors; overall survival; progression free survival; propensity score matching.

Publication types

Multicenter Study

MeSH terms

Aged
Antineoplastic Combined Chemotherapy Protocols / adverse effects
Female
Humans
Progression-Free Survival
Propensity Score
Retrospective Studies
Stomach Neoplasms* / pathology