Palliative chemotherapy and targeted therapies for esophageal and gastroesophageal junction cancer

Abstract

People who receive more chemotherapeutic or targeted therapeutic agents have an increased overall survival compared to people who receive less. These agents, administered as both first-line or second-line treatments, also led to better overall survival than best supportive care. With the exception of ramucirumab, it remains unclear which other individual agents cause the survival benefit. Although treatment-associated toxicities of grade 3 or more occurred more frequently in arms with an additional chemotherapy or targeted therapy agent, there is no evidence that palliative chemotherapy and/or targeted therapy decrease quality of life. Based on this meta-analysis, palliative chemotherapy and/or targeted therapy can be considered standard care for esophageal and gastroesophageal junction carcinoma.

Heterogeneity of first‐line palliative systemic treatment in synchronous metastatic esophagogastric cancer patients: A real‐world evidence study

“…The use of an unusual treatment regimen may limit opportunities for second-line treatment and subsequent OS benefit. [4][5][6]14 In our study, we found less serious (grade 3-5) toxicity in patients receiving doublets (21%) compared to triplets (33%) as well as similar OS and TTF rates, which supports the shift toward doublet therapy as preferred strategy in these patients. Current national and international guidelines recommend a fluoropyrimidine and platinum doublet in metastatic esophagogastric cancer patients, with the addition of an anthracycline or taxane in selected patients.…”

“…In the curative setting, docetaxel, oxaliplatin and 5-FU/leucovorin (FLOT) showed longer survival in gastric cancer when used as a perioperative regimen as compared to anthracycline triplets. [4][5][6] In addition, grade 3-5 toxicity rate was only marginally lower compared to doublets (18% vs. 21%, respectively). 31 However, in the palliative setting, it remains inconclusive whether first-line taxane triplets or fluoropyrimidine doublets followed by second-line taxanes should be preferred in view of survival benefit and toxicity.…”

“…30 The use of FLOT followed by resection with curative intent in patients with limited metastatic disease is currently being explored in the AIO-FLOT5 trial. 4,5 Year (Table 2a) as well as regimens (Table 2b) A relatively high rate of grade 3-5 toxicity (45%) was seen in patients who received trastuzumab-containing regimens. 6,11 Monotherapy showed a significantly worse OS compared to doublets, which is in line with recently published reviews.…”

“…[7][8][9][10][11] Triplet therapy, in which either an anthracycline or taxane is added to the platinum-fluoropyrimidine doublet, is suggested in international guidelines for patients in good condition, 8,10,12,13 but becomes increasingly controversial because of its toxicity. [4][5][6] Because of, for example, the underrepresentation of elderly and fragile patients in these trials, the actual patient population may not be adequately reflected. This could eventually affect survival and quality of life, and might be the explanation for stagnating survival rates, despite an increase in the administration of palliative systemic therapy from <10% to 40% of metastatic esophagogastric cancer patients between 1990 and 2011 in the Netherlands.…”

Association between body composition, survival, and toxicity in advanced esophagogastric cancer patients receiving palliative chemotherapy

“…1,2 Palliative chemotherapy is considered standard treatment because it can improve survival and quality of life in incurable esophagogastric cancer patients. 3,4 Currently, doublet therapy with a fluoropyrimidine and platinum compound is recommended as first-line palliative chemotherapy, providing a survival benefit of several months. 5,6 Unfortunately, chemotherapy often causes toxicity, which may result in dose reductions, suspension, and discontinuation of chemotherapy and can thereby compromise treatment efficacy.…”