AUTHOR=Walden Daniel , Sonbol Mohamad Bassam , Buckner Petty Skye , Yoon Harry H. , Borad Mitesh , Bekaii-Saab Tanios S. , Ahn Daniel H. 

TITLE=Maintenance Therapy in First-Line Gastric and Gastroesophageal Junction Adenocarcinoma: A Retrospective Analysis

JOURNAL=Frontiers in Oncology

VOLUME=Volume 11 - 2021

YEAR=2021

URL=https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.641044

DOI=10.3389/fonc.2021.641044

ISSN=2234-943X

ABSTRACT=Background
Fluoropyrimidine with platinum-based chemotherapy have become the standard of care for advanced gastric and gastroesophageal (GEJ) cancer. In other colorectal cancer, induction chemotherapy followed by maintenance chemotherapy is a strategy to maximize clinical response while minimizing toxicity. The current retrospective study aims to evaluate efficacy and tolerability of maintenance vs continuous treatment in advanced GEJ malignancy.
	
Methods
A retrospective analysis of patients with metastatic gastric/GEJ adenocarcinoma treated with fluoropyrimidine and platinum chemotherapy between 2007-2017 was performed. Patients who achieved at least stable disease after initial induction treatment were included. After 16 weeks of induction chemotherapy, patients were categorized into the continuous group if induction chemotherapy was continued and maintenance group if chemotherapy was switched to maintenance fluoropyrimidine monotherapy or observed off treatment. Endpoints were progression free survival (PFS), overall survival (OS), and toxicities. 
Results
Ninety patients met criteria, 48 received continuous therapy and 42 received maintenance. Baseline characteristics were comparable. No difference in PFS (9.9 vs 8.4 months p = .28) or in OS (16.1 vs 21.3 months p = .75) was observed, including after controlling for best response on induction therapy and other variables. In patients on continuous induction therapy, there was a higher prevalence of grade three neuropathy (42.6% vs 9.8% p = .001) and neutropenic fever (13% vs 0% p =.03). 

Conclusions
Maintenance therapy following induction fluoropyrimidine and platinum based therapy is associated with an improved toxicity profile and appears to have comparable efficacy to continuous treatment in metastatic gastric/GEJ cancer.