Studies on the effects of third-line chemotherapy (CT) in advanced gastric cancer (GC) patients are still scarce. The aim of this study was to evaluate the efficacy and safety of the modified 5-fluorouracil, leucovorin, and irinotecan (mFOLFIRI) regimen as a third-line CT in metastatic GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane. After failure of first- and second-line therapies, 42 patients received third-line FOLFIRI (180 mg/m² irinotecan and 400 mg/m² leucovorin administered concomitantly as a 90-minute intravenous (IV) infusion on day 1, followed by a 400 mg/m² 5-fluorouracil IV bolus then 2600 mg/m² continuous infusion over 46 hours), between January 2009 and December 2015. FOLFIRI was administered for a median of 6 cycles (range 4-12 cycles). Eight patients achieved partial response, while 13 patients showed stable disease, resulting in the overall response rate (ORR) of 19% and disease control rate (DCR) of 50%. The most frequent grade 3-4 hematological and non-hematological toxicities were neutropenia (14.2%) and diarrhea (7.1%). The median progression-free survival (PFS) and overall survival (OS) from the start of third-line CT were 3.8 months (95% confidence interval [CI], 3.0-4.5) and 6.8 months (95% CI, 5.6-7.9), respectively. According to the multivariate analysis, two factors were independently predictive of the poor OS: >2 regions of metastasis (relative risk [RR], 2.6; 95% CI, 1.3-5.4) and a high level of carcinoembryonic antigen [CEA] (RR, 3.4; 95% CI, 1.6-7.4). In conclusion, FOLFIRI was well tolerated as third-line CT and showed promising PFS and OS in advanced GC patients, after failure of fluoropyrimidine, platinum, anthracycline, and taxane.

中文翻译：

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在氟嘧啶，铂，蒽环类和紫杉烷类药物治疗失败后，将5-氟尿嘧啶，亚叶酸钙蛋白和伊立替康（FOLFIRI）作为转移性胃癌的三线化疗药物。

关于晚期胃癌（GC）患者的三线化疗（CT）效果的研究仍然很少。这项研究的目的是评估在氟嘧啶，铂，蒽环类和紫杉烷类药物治疗失败后，改良的5-氟尿嘧啶，亚叶酸和伊立替康（mFOLFIRI）方案作为转移性GC患者的三线CT的疗效和安全性。一线和二线治疗失败后，有42例患者接受了三线FOLFIRI（在第1天以90分钟静脉（IV）输注方式同时服用伊立替康180 mg /m²和亚叶酸400 mg /m²在2009年1月至2015年12月之间，先将5 mg /m²5-氟尿嘧啶静脉推注，然后在46小时内连续输注2600 mg /m²。FOLFIRI的中位数为6个周期（4-12个周期）。8名患者获得了部分缓解，13例患者病情稳定，总体缓解率（ORR）为19％，疾病控制率（DCR）为50％。3-4级血液和非血液学毒性最常见的是中性粒细胞减少症（14.2％）和腹泻（7.1％）。从三线CT开始开始的中位无进展生存期（PFS）和总体生存期（OS）为3.8个月（95％置信区间[CI]，3.0-4.5）和6.8个月（95％CI，5.6-7.9） ）， 分别。根据多因素分析，有两个因素可以独立预测OS不良：> 2个转移区域（相对危险度[RR]，2.6； 95％CI，1.3-5.4）和高水平的癌胚抗原[CEA]（RR ，3.4； 95％CI，1.6-7.4）。总之，FOLFIRI作为三线CT耐受性良好，并且在氟嘧啶失效，晚期GC患者中表现出有希望的PFS和OS