Objective  To explore appropriate second-line treatment regimens for advanced gastric/gastroesophageal junction (G/GEJ) adenocarcinoma.

  Methods  We retrospectively analyzed the clinical data of patients with advanced G/GEJ adenocarcinoma treated with paclitaxel monotherapy and paclitaxel in combination with anti-vascular or programmed cell death receptor 1 (PD-1) monoclonal antibody as second-line therapy at Henan Cancer Hospital from January 2019 to March 2021.

  Results  The clinical data of 101 patients were collected with a median follow-up time of 10.4 months and a median overall survival (OS) of 9.5 months. In the paclitaxel monotherapy (43 cases), paclitaxel combined with anti-vascular (22 cases), and paclitaxel combined with immune (36 cases) groups, the objective response rates (ORR) were 9.3%, 27.3%, and 30.6%, respectively; the disease control rates (DCR) were 60.5%, 86.4%, and 80.6%, respectively; the median progression-free survival (PFS) was 2.7 months, 4.3 months, and 3.9 months, respectively; and the median OS was 7.0 months, 12.0 months, and 11.0 months, respectively, which were statistically significant (P<0.05). Adverse reactions in all three groups were controllable, and no novel adverse events occurred. The incidence of hypertension in the combined anti-vascular group was 40.9% (9/22) and that of immune-related adverse reactions in the combined PD-1 monoclonal antibody group was 19.4% (7/36), both of which were statistically significant compared with those in the other two groups (P < 0.05). A multifactorial analysis showed that the Eastern Cooperative Oncology Group (ECOG) score and peritoneal metastasis were independent influencing factors for patients’ OS (P< 0.05).

  Conclusions  Paclitaxel combined with anti-vascular or PD-1 monoclonal antibody can effectively and safely prolong the PFS and OS of patients and is a second-line treatment option for advanced G/GEJ adenocarcinoma.