Real-World Treatment Patterns and Outcomes in Patients Receiving Second-Line Therapy for Advanced/Metastatic Esophageal Squamous Cell Carcinoma

Abstract

Introduction: Currently available second-line (2L) therapies for advanced/metastatic esophageal squamous cell carcinoma (adv/met ESCC) include the taxanes paclitaxel and docetaxel. In clinical trials, such therapies have provided only modest improvements in survival. Few studies have assessed outcomes in routine clinical practice in the USA. We compared realworld clinical outcomes in the US for patients receiving taxane or non-taxane 2L therapy for adv/met ESCC. Methods: The Flatiron Health database was used to identify patients diagnosed with adv/ met ESCC (1 January 2011-31 January 2019) who received 2L therapy; index date was date of adv/met diagnosis. Baseline variables and treatment regimens received were identified. Overall survival (OS; 2L start until death or last recorded medical activity) and duration of therapy (DoT; start of 2L therapy until last administration date of 2L therapy) in patients receiving taxane vs. non-taxane-based therapies in the 2L setting were estimated by Kaplan-Meier method. Results: There were no clear differences in baseline characteristics between patients who received 2L taxane therapy (n = 37) and 2L nontaxane therapy (n = 49). Median (95% CI) 2L OS was significantly longer with 2L taxanes (7.3 [5.9-11.5] months) vs. 2L non-taxanes (5.1 [2.9-7.6] months); median (95% CI) 2L DoT was 2.1 (1.8-3.0) months vs. 3.3 (2.6-6.7) months, respectively. Conclusion: Survival was generally poor in patients receiving 2L therapy for adv/met ESCC and was longer in patients receiving 2L taxanes than 2L non-taxane therapy. Efficacious, tolerable therapies for ESCC in the 2L setting are urgently needed.

Rh-Endostatin Plus Irinotecan/Cisplatin as Second-Line Therapy for Advanced Esophageal Squamous Cell Carcinoma: An Open-Label, Phase II Study

“… 8 , 9 Although NCCN Guidelines provide recommended options for second-line therapy in advanced or metastatic ESCC, much of the evidence base focused on esophageal adenocarcinoma and did not specifically consider ESCC. 10 Therefore, the optimal second-line therapeutic strategy for ESCC remained controversial. To address this issue, the present study aimed to evaluate a promising new second-line therapy option for advanced ESCC patients.…”

Treatment patterns and survival in advanced unresectable esophageal squamous cell cancer: A population‐based study

“…In ATTRACTION‐3, survival time of patients in the control arm (all receiving taxane monotherapy) was higher at 8.4 months 8 . In a real‐world study of patients with ESCC, the survival of patients receiving second‐line taxane monotherapy (7.3 months) was longer compared with patients receiving other second‐line regimens (5.1 months) 28 . In our study, 22% of patients received second‐line taxane monotherapy and this could explain the shorter survival time compared with ATTRACTION‐3.…”

Benefit of second-line therapy for advanced esophageal squamous cell carcinoma: a tri-center propensity score analysis

“…Notably, in that study the majority of patients was treated with a combination chemotherapy of carboplatin plus paclitaxel, whereas in our study taxanes were administered as a singleagent regimen. 37 We finally aimed to identify predictive markers for second line therapy benefit. In an exploratory propensity score adjusted subgroup analysis we found that the favorable association between longer OS and second-line therapy was consistent across several relevant clinical subgroups.…”

“…Notably, in that study the majority of patients was treated with a combination chemotherapy of carboplatin plus paclitaxel, whereas in our study taxanes were administered as a single-agent regimen. 37 …”