A phase III study showed that second-line treatment with the chemotherapy drug docetaxel results in markedly longer overall survival compared with active symptom control for patients with advanced oesophago-gastric cancer whose disease progressed despite first-line chemotherapy.

While this strategy is already widely used, the new study provides definitive evidence of survival benefit for second-line therapy with docetaxel.

Oesophago-gastric cancers include cancers of the oesophagus, stomach, and oesophago-gastric junction.

Approximately 39,000 new cases of these malignancies are diagnosed in the United States each year. 

Adenocarcinoma is the most common form of oesophago-gastric cancer and the incidence of esophageal adenocarcinoma is on the rise.

Patients with oesophago-gastric adenocarcinoma have poor outcomes with currently available therapies.

All patients who present with advanced disease at diagnosis, and most (60-70 percent) who present with local disease, relapse after first-line chemotherapy. Without second-line therapy, the median survival time is 3 months.

“Current practice in the United States and a lot of Europe is to give second-line chemotherapy to patients with oesophago-gastric cancers, even though the evidence isn’t as strong as we would like,” said Hugo Ford, MD, lead author on the study and director of cancer services at Addenbrooke’s Hospital in Cambridge, UK.

“This is the first trial to show second-line chemotherapy extends survival, without causing deterioration in quality of life.”

In this UK-based trial, 168 patients with locally advanced or metastatic oesophago-gastric adenocarcinoma whose disease progressed within 6 months of initial chemotherapy were randomly assigned to receive either docetaxel or active symptom control (radiotherapy, steroids and/or supportive medications).

The median overall survival among patients who received docetaxel was 5.2 months, roughly 50 percent longer than the 3.6 months among those who received active symptom control.

The survival benefit was evident across the different tumour sites and stages of cancer and did not differ by patient age or gender. The greatest benefit was observed in patients with performance status 0 (asymptomatic or fully active).

Preliminary analysis of overall and disease-specific quality of life suggests that patients receiving secondline therapy with docetaxel have improved pain scores and no loss in global quality of life.

Besides docetaxel, patients with esophago-gastric cancers may receive irinotecan and paclitaxel as second-line therapy.

The results of this study affirm docetaxel as a standard second-line therapy in the UK and provide supporting evidence for clinicians outside of the UK to inform their choice of treatment.

Source: ASCO