Comparison of efficacy and tolerability of single agent and double agent chemotherapy regimens in first-line treatment of elderly patients with her-2 negative metastatic gastric cancer

Aims: Chemotherapy remains a cornerstone in treating metastatic gastric cancer (GC), yet the management of elderly patients, who often face distinct challenges, lacks comprehensive guidelines. The aim of this study was to compare the efficacy and side effects of single-agent and double-agent chemotherapy regimens in first-line treatment of elderly patients with HER-2 negative metastatic GC. Methods: We retrospectively evaluated HER-2 negative metastatic GC patients aged 80 years and older who were treated at Van Yüzüncü Yıl University Medical Faculty Dursun Odabaşı Medical Center Oncology Clinic between 2010 and 2023. Demographic characteristics, treatment regimens and responses, prognostic factors, grade 3-4 toxicity, progression-free survival (PFS), and overall survival (OS) were analyzed. Results: The mean age of 56 patients was 82.6 ± 2.3 years and 24 (42.9%) of them were women. Single-agent chemotherapy was administered to 33 (58.9%) patients, while 23 (41.1%) received double-agent chemotherapy. The median OS was 5 months (95% CI, 2.9 to 7.1) in the single-agent group and 10 months (95% CI, 4.2 to 15.8) in the double-agent group (p = 0.237), although there was a numerical difference, it was not statistically significant. Median PFS was longer with double-agent chemotherapy, but not statistically significant (6 months vs. 4 months, p = 0.668). No statistically significant difference was found in the side effect rates of patients receiving single and double-agent chemotherapy. Conclusion: In our study, despite the absence of statistical significance in the survival rates among patients receiving double chemotherapeutic agents, their survival was twice as long as that of individuals receiving a single agent. Furthermore, no significant differences in terms of side effects were observed. These findings suggest that, even in individuals aged 80 years and older, a preference for double-agent chemotherapy should be considered when feasible.