Metronomic Capecitabine for Elderly Advanced Gastric Carcinoma Patients Pretreated With One or Two Systemic Chemotherapy Lines

Background: The aim of this study was to investigate the efficacy and safety of metronomic capecitabine chemotherapy in pretreated elderly patients with advanced gastric carsonoma. Patients and Methods: Eligible patients were treated with capecitabine at a fixed dose of 1000mg daily until disease progression or toxicity. Endpoints were overall response rate, safety, progression-free survival and overall survival. Results: Thirty eight patients were enrolled (June 2004 to October 2011) with a median age of 69 years. Two patients refused continuation due to deterioration of general condition; consequently, 36 out of 38 patients were assessed for response. No complete response was observed while 6 patients out of 36 patients (16.7%) achieved partial response, 13 (36.1%) showed stable disease and 17 (47.2%) showed progression of disease. The disease control rate (response rate + stability rate) was 52.8%. The most common hematologic adverse effects were neutropenia in 3 (8.3%), followed by mucositis in 2 (5.6%) patients. There was one reported case of neutropenic fever. The reported hand-foot syndrome cases were all lower than grade 3. There were no treatment-related deaths and treatment delays were observed in 8 patients. Symptomatic improvement was evident in 18 patients (50 %). Median follow-up period was 6.5 months. Median time to progression was 3 months (range: 0 to7 months), while the median overall survival was 7 months (range: 3 to15 months). Conclusion: Metronomic capecitabine may be considered an effective and tolerable treatment option in elderly patients with pretreated advanced gastric cancer after the failure of previous lines of chemotherapy.