Comparison of FOLFIRI and Paclitaxel as Second-Line Chemotherapy in Metastatic HER2-Negative Gastric Cancer: A Real-World Retrospective Analysis
Mehmet Cem Fidan1, Hamza Abbasov1, Vali Aliyev1, Shamkal Safarov1, Emir Çerme1, Nebi Serkan Demirci1, Özkan Alan11Division of Medical Oncology, Department of Internal Medicine, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
Objectives: Gastric cancer is among the leading causes of cancer-related deaths worldwide, and outcomes in the metastatic setting remain poor. While FOLFIRI and weekly paclitaxel are widely used as second-line options for HER2-negative disease, head-to-head comparative data are largely absent. Methods: We retrospectively reviewed the records of 68 patients with metastatic HER2-negative gastric adenocarcinoma who received either FOLFIRI (n=55) or paclitaxel (n=13) as second-line chemotherapy at a single center between August 2013 and March 2023. Survival outcomes were estimated using the Kaplan-Meier method, and independent prognostic factors were identified using Cox regression analysis. Results: The median PFS numerically favored FOLFIRI over paclitaxel (3.9 vs. 2.8 months; log-rank p=0.052) without reaching statistical significance; on multivariate Cox analysis, FOLFIRI independently predicted longer PFS (HR, 0.474; 95% CI, 0.245–0.918; p=0.027). OS was comparable between the two arms (8.5 vs. 5.5 months; log-rank p=0.580). Multivariate analysis revealed that intestinal-type Lauren classification (HR, 0.378; p=0.006), elevated CEA (HR, 4.879; p<0.001), and metachronous metastatic disease (HR, 2.313; p=0.012) emerged as independent prognostic factors for OS. Conclusion: FOLFIRI was associated with longer PFS than paclitaxel and independently predicted PFS on multivariate analysis, although overall survival was similar between groups. These hypothesis-generating findings suggest that both regimens are reasonable second-line options, and prospective randomized trials with adequate power and standardized biomarker profiling are required to define the optimal approach. Keywords: FOLFIRI, Metastatic Gastric Cancer, Overall
Cite This Article
Fidan M, Abbasov H, Aliyev V, Safarov S, Çerme E, Demirci N, Alan Ö. Comparison of FOLFIRI and Paclitaxel as Second-Line Chemotherapy in Metastatic HER2-Negative Gastric Cancer: A Real-World Retrospective Analysis. EJMI. 2026; 10(3): 345-358
Corresponding Author: Mehmet Cem Fidan