Feasibility of systemic therapy in unresectable gastric/gastroesophageal junction cancer with overt bleeding.

Objective: To evaluate the feasibility of modified systemic anti-cancer therapy in unresectable gastric cancer or gastroesophageal junction cancer (GC/GEJC) patients with overt bleeding (OB). Methods: This retrospective study included individuals with unresectable GC/GEJC and OB who received systemic anti-cancer therapy. Treatment feasibility was assessed. Risk factors for persistent overt bleeding post systemic therapy (POBPST) were explored. Results: Among the 52 individuals included, 19 (36.5%) experienced active OB within one month prior to initiating anti-cancer therapy, while 33 (63.5%) did not. Hemostasis was achieved via endoscopic intervention in 2 patients and conservative medical management in 17. A total of 5 patients received immune checkpoint inhibitor monotherapy, and 47 received chemotherapy-based systemic therapy, with 70.2% (33/47) requiring a 25% dose reduction. Among those with active OB, 73.7% (14/19) received intravenous therapy, with a median interval of 16 days (range: 3-25) from hemostasis to treatment initiation. The overall objective response rate (ORR) and disease control rate (DCR) were 42.3% and 90.4%, respectively. Median progression-free survival (mPFS) and overall survival (mOS) were 10.3 and 16.1 months. POBPST occurred in 28.8% of individuals and was associated with poorer survival. Grade 3-4 treatment-related adverse events occurred in 36.5% of patients. Multivariate analysis identified a Modified Barthel Index (MBI) score < 75 and disease progression or stable disease as independent risk factors for POBPST. Conclusions: With appropriate hemostatic management, modified dose systemic anti-cancer therapy was feasible and generally well tolerated in patients with unresectable GC/GEJC and OB. Nurses' role was indispensable for this high-risk population. Trial registration: The study has been registered in clinical trials.gov (NCT06522542).