Outcomes relative to paclitaxel dose-intensity when administered with ramucirumab in gastric and gastroesophageal junction (GEJ) adenocarcinoma.
Bibliographic record
Abstract
e16539 Background: Combination paclitaxel (PTX) and ramucirumab (RAM) is standard second-line treatment for gastric and GEJ cancers. Peripheral neuropathy (PN) is considered a potential obstacle to administering a maximal dose of PTX, potentially limiting efficacy. We sought to determine the dose-intensity and outcomes for patients receiving this treatment. Methods: A retrospective analysis of gastric and GEJ cancer patients treated at Princess Margaret Cancer Centre (2012-2017) was performed identifying all patients who received PTX and RAM during their treatment course. The primary objective was to determine the dose-intensity of PTX administration. Secondary objectives included identification of the reason for dose-reduction (DR), and comparing progression-free survival (PFS) and overall survival (OS) in relation to PTX DR. Results: 45 patients were included in the study. Mean age was 57.2y, 34 (76%) were male, 7 (16%) were Asian, 5 (11%) patients were her2 positive. 42 (93%) patients received first-line treatment containing a potential neuro-toxic agent (cisplatin, oxaliplatin, docetaxel or paclitaxel). 22 (49%) subjects required PTX DR. The median number of cycles administered for subjects not requiring a DR and those with dose-reduced PTX was 3 v 6 (p < 0.001) respectively, with the median number of PTX doses administered 8 v 15 (p0.0022). The mean dose-intensity was 100 v 83% (p < 0.001). PN was the reason for DR in 32% (n = 7) of subjects, whilst neutropenia was 41% (n = 9). The reason for treatment cessation was disease progression in 91% of subjects, irrespective of whether they required a DR or not. Median PFS was 2.8m (95% CI 2.1-4.8) (100% dose PTX) and 5.5m (95% CI 4.8-8.6) in those requiring a DR (p0.0006). Median OS, measured from the initial diagnosis of incurable/metastatic disease was 16.4m (95% CI 13.7-22.9) and 18.5m (95% CI 14.9-47.5) respectively (p0.0953). Conclusions: Approximately half of the patients required a PTX DR, of whom a clinically significant 32% were DR due to PN, slightly less than those DR due to neutropenia. PFS was longer in those requiring a DR, which may reflect that those on treatment longer are more likely to experience toxicity and require a subsequent DR. PTX DR did not significantly affect OS, thus whilst PTX toxicity remains a clinical concern we did not identify that a DR resulted in an appreciable difference in treatment efficacy.
Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.
How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".