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Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer

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Abstract

Purpose

Second-line chemotherapy has been shown to benefit patients with advanced gastric cancer (AGC), extending the overall survival (OS) and progression-free survival (PFS). This study aimed to assess the efficacy and cost-effectiveness of second-line treatment for elderly patients with AGC.

Methods

Medical records and follow-up information of elderly patients (≥70 years) with AGC who received second-line chemotherapy were collected. A Markov model comprising three health states PFS, progressive disease and death was developed to simulate the process of AGC. Cost was calculated from the perspective of Chinese society. Sensitivity analyses were applied to explore the impact of essential variables.

Results

Forty-three elderly patients with AGC receiving second-line chemotherapy were included in our study. The median OS was 6.0 months (95% confidence interval (CI) 3.90–8.10) and PFS was 3.1 months (95% CI 1.38–4.82). No treatment-related death occurred. The most frequently drug-related grade 3/4 AEs were diarrhea (2.3%), leukopenia (16.3%) and nausea (7.0%). The incremental cost-effective ratio was $18,223.75/QALY for second-line chemotherapy versus BSC, which was below the threshold of 3× the per capita GDP of China, $23,970.00.

Conclusion

Second-line chemotherapy was an optimal strategy for elderly AGC patients in China from the efficacy and cost-effectiveness perspective.

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Author notes

    Authors and Affiliations

    1. Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China

      K. Zhou, F. Wen, P. Zhang, J. Zhou, H. Chen, Y. Yang & Q. Li

    2. West China Biostatistics and Cost-Benefit Analysis Center, Sichuan University, Chengdu, China

      K. Zhou, F. Wen, P. Zhang, J. Zhou, H. Chen, H. Zheng, Y. Yang & Q. Li

    3. Department of Clinical Pharmacy, West China Hospital, Sichuan University, Chengdu, China

      H. Zheng

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    1. K. Zhou
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    2. F. Wen
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    3. P. Zhang
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    4. J. Zhou
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    5. H. Chen
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    Correspondence to Y. Yang or Q. Li.

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    Ethical standards

    All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (Research Ethics Committees of West China Hospital, Sichuan University) and with the Helsinki Declaration of 1964 and later versions.

    Informed consent

    All persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study were omitted.

    Conflict of interest

    The authors declare that they have no conflict of interest.

    Additional information

    K. Zhou and F. Wen contributed equally to this work.

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    Zhou, K., Wen, F., Zhang, P. et al. Efficacy and cost-effectiveness of second-line chemotherapy in elderly patients with advanced gastric cancer. Clin Transl Oncol 19, 1117–1124 (2017). https://doi.org/10.1007/s12094-017-1647-9

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    • DOI: https://doi.org/10.1007/s12094-017-1647-9

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