Utilization and Efficacy of Palliative Chemotherapy for Locally Advanced or Metastatic Gastroesophageal Carcinoma

Baumgartner, Ruth; Taghizadeh, Hossein; Jomrich, Gerd; Schoppmann, Sebastian F.; Preusser, Matthias; Ilhan-Mutlu, Aysegül

doi:10.21873/anticanres.14030

Cited by 12 publications

(9 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In patients diagnosed with advanced esophageal cancer, a clinically significant proportion of patients decline did not receive chemotherapy and often opt for best supportive care[ 12 ]. Palliative chemotherapy in this population has been positively associated with an OS benefit, but grade 3-5 toxicity rates have been shown to be a relevant 33%-48% with platinum-based doublet regimens[ 26 , 27 ]. Other palliative modalities for esophageal cancer have historically included surgery, radiation therapy, nutritional optimization, relief of obstruction, pain control, or a combination of the above[ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

Kim¹,

DiPeri²,

Guan³

et al. 2020

WJGS

View full text Add to dashboard Cite

BACKGROUND Palliative therapy has been associated with improved overall survival (OS) in several tumor types. Not all patients with metastatic esophageal cancer receive palliative chemotherapy, and the roles of other palliative therapies in these patients are limited. AIM To investigate the impact of other palliative therapies in patients with metastatic esophageal cancer not receiving chemotherapy. METHODS The National Cancer Database was used to identify patients between 2004-2015. Patients with M1 disease who declined chemotherapy and had known palliative therapy status [palliative therapies were defined as surgery, radiotherapy (RT), pain management, or any combination thereof] were included. Cases with unknown chemotherapy, RT, or nonprimary surgery status were excluded. Kaplan-Meier estimates of OS were calculated. Cox proportional hazards regression models were employed to examine factors influencing survival. RESULTS Among 140234 esophageal cancer cases, we identified 1493 patients who did not receive chemotherapy and had complete data. Median age was 70 years, most (66.3%) had a Charlson Comorbidity Index (CCI) of 0, and 37.1% were treated at an academic center. The majority (72.7%) did not receive other palliative therapies. On both univariate and multivariable analyses, there was no difference in OS between those receiving other palliative therapy (median 2.83 mo, 95%CI: 2.53-3.12) vs no palliative therapy (2.37 no, 95%CI: 2.2-2.56; multivariable P = 0.290). On univariate, but not multivariable analysis, treatment at an academic center was predictive of improved OS [Hazard ratio (HR) 0.90, 95%CI: 0.80-1.00; P = 0.047]. On multivariable analysis, female sex (HR 0.81, 95%CI: 0.71-0.92) and non-black, other race compared to white race (HR 0.72, 95%CI: 0.56-0.93) were associated with reduced mortality, while South geographic region relative to West region (HR 1.23, 95%CI: 1.04-1.46) and CCI of 1 relative to CCI of 0 (HR 1.17, 95%CI: 1.03-1.32) were associated with increased mortality. Higher histologic grade and T-stage were also associated with worse OS ( P < 0.05). CONCLUSION Palliative therapies other than chemotherapy conferred a numerically higher, but not statistically significant difference in OS among patients with metastatic esophageal cancer not receiving chemotherapy. Quality of life metrics, inpatient status, and subgroup analyses are important for examining the role of palliative therapies other than chemotherapy in metastatic esophageal cancer and future studies are warranted.

show abstract

Section: Discussionmentioning

confidence: 99%

Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

Kim¹,

DiPeri²,

Guan³

et al. 2020

WJGS

View full text Add to dashboard Cite

show abstract

“…Most of the patients tend to be diagnosed at advanced stages and lost the opportunity for operation. For these patients with advanced gastroesophageal cancer, combined chemotherapy based on 5fluorouracil and platinum is the standard first-line treatment [2]. However, it is easy to develop drug resistance and result in disease progression after first-line treatment, while the efficacy of the following chemotherapy regime is not desirable with severe side effects.…”

Section: Introductionmentioning

confidence: 99%

PD-1/PD-L1 Inhibitors versus Chemotherapy for Previously Treated Advanced Gastroesophageal Cancer: A Meta-Analysis of Randomized Controlled Trials

Zhong

Xue

Zeng

et al. 2021

Journal of Oncology

View full text Add to dashboard Cite

Patients with advanced gastroesophageal cancer refractory to the previous regimen of chemotherapy suffered from poor prognosis without many effective treatment options. Immune checkpoint inhibitors (ICIs) provide promising efficacy, but the relevant clinical trials have offered controversial data. We performed this meta-analysis to compare the efficacy and safety of inhibitors against programmed cell death receptor 1 (PD-1) and its ligand PD-L1 versus chemotherapy as second or third-line therapy in patients with advanced gastroesophageal cancer. Six randomized controlled trials (RCTs) including 2,648 patients were included. The meta-analysis results indicated that both ORR (RR = 1.39, 95% CI: 0.85∼2.25, P = 0.188) and PFS (HR = 1.14, 95% CI: 0.88∼1.46, P = 0.316) were not significantly improved by ICIs compared with chemotherapy. However, the OS was significantly prolonged (HR = 0.85, 95% CI: 0.75–0.97, P = 0.018) in the ICIs group compared with chemotherapy. Subgroup analysis showed that ICIs provide statistically significant OS benefits over chemotherapy in PD-L1-positive, squamous cell carcinoma, Asia origin, esophageal cancer, second-line treatment, male, and aged 65 or older patients. Compared with chemotherapy, the TRAEs risk of ICIs was reduced by 33% (RR = 0.67, 95% CI: 0.62–0.73, P ≤ 0.001). And the risk of grades 3–5 of TRAEs was reduced by 60% (RR = 0.40, 95% CI: 0.33–0.49, P ≤ 0.001). Compared to chemotherapy, ICIs appeared to improve OS and were better tolerated in previously treated patients with advanced esophageal cancer. We recommend PD-1/PD-L1 inhibitors as an optimal treatment option for positive PD-L1 expression, squamous cell carcinoma, Asia origin, esophageal cancer, second-line treatment, male, and ≥65 years of age patients.

show abstract

“…As an example, in one study only 18% of patients with advanced gastroesophageal cancer patients received chemotherapy, with the most common treatment being supportive care alone (21%)[ 7 ]. The adverse effects of chemotherapy in metastatic esophageal cancer can be significant, with grade 3-5 toxicity rates as high as 33%-48% with platinum-based doublet regimens[ 8 , 9 ]. Current National Comprehensive Cancer Network (NCCN) guidelines recommend systemic therapy for those with favorable Eastern Cooperative Oncology Group (ECOG) or Karnofsky performance status[ 10 ].…”

Section: Introductionmentioning

confidence: 99%

Chemotherapy predictors and a time-dependent chemotherapy effect in metastatic esophageal cancer

Midthun¹,

Kim²,

Hendifar³

et al. 2022

WJGO

View full text Add to dashboard Cite

BACKGROUND Chemotherapy has long been shown to confer a survival benefit in patients with metastatic esophageal cancer. However, not all patients with metastatic disease receive chemotherapy. AIM To evaluate a large cancer database of metastatic esophageal cancer cases to identify predictors of receipt to chemotherapy and survival. METHODS We interrogated the National Cancer Database (NCDB) between 2004-2015 and included patients with M1 disease who had received or did not receive chemotherapy. A logistic regression model was used to examine the associations between chemotherapy and potential confounders and a Cox proportional hazards model was employed to examine the effect of chemotherapy on overall survival (OS). Propensity score analyses were further performed to balance measurable confounders between patients treated with and without chemotherapy. RESULTS A total of 29182 patients met criteria for inclusion in this analysis, with 21911 (75%) receiving chemotherapy and 7271 (25%) not receiving chemotherapy. The median follow-up was 69.45 mo. The median OS for patients receiving chemotherapy was 9.53 mo (9.33-9.72) vs 2.43 mo (2.27-2.60) with no chemotherapy. Year of diagnosis 2010-2014 [odds ratio (OR): 1.29, 95% confidence interval (CI): 1.17-1.43, P value < 0.001], median income > $46000 (OR: 1.49, 95%CI: 1.27-1.75, P value < 0.001), and node-positivity (OR: 1.35, 95%CI: 1.20-1.52, P < 0.001) were independent predictors of receiving chemotherapy, while female gender (OR: 0.86, 95%CI: 0.76-0.98, P = 0.019), black race (OR: 0.76, 95%CI: 0.67-0.93, P = 0.005), uninsured status (OR: 0.41, 95%CI: 0.33-0.52, P < 0.001), and high Charlson Comorbidity Index (CCI) (OR for CCI ≥ 2: 0.61, 95%CI: 0.50-0.74, P < 0.001) predicted for lower odds of receiving chemotherapy. Modeling the effect of chemotherapy on OS using a time-dependent coefficient showed that chemotherapy was associated with improved OS up to 10 mo, after which there is no significant effect on OS. Moreover, uninsured status [hazard ratio (HR): 1.20, 95%CI: 1.09-1.31, P < 0.001], being from the geographic Midwest (HR: 1.07, 95%CI: 1.01-1.14, P = 0.032), high CCI (HR for CCI ≥ 2: 1.16, 95%CI: 1.07-1.26, P < 0.001), and higher tumor grade (HR for grade 3 vs grade 1: 1.28, 95%CI: 1.14-1.44, P < 0.001) and higher T stage (HR for T1 vs T4: 0.89, 95%CI: 0.84-0.95, P < 0.001) were independent predictors of worse OS on multivariable analyses. CONCLUSION In this large, retrospective NCDB analysis, we identified several socioeconomic and...

show abstract

Utilization and Efficacy of Palliative Chemotherapy for Locally Advanced or Metastatic Gastroesophageal Carcinoma

Cited by 12 publications

References 31 publications

Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

Impact of palliative therapies in metastatic esophageal cancer patients not receiving chemotherapy

PD-1/PD-L1 Inhibitors versus Chemotherapy for Previously Treated Advanced Gastroesophageal Cancer: A Meta-Analysis of Randomized Controlled Trials

Chemotherapy predictors and a time-dependent chemotherapy effect in metastatic esophageal cancer

Contact Info

Product

Resources

About