Chemotherapy versus Supportive Care Alone for Relapsed Gastric, Gastroesophageal Junction and Oesophageal Adenocarcinoma: a Meta-analysis of Patient Level Data
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Authors
Janowitz, Tobias
Thuss-Patience, Peter
Marshall, Andrea
Kang, Jung Hun
Cook, Natalie
Dunn, Janet
Park, Se Hoon
Ford, Hugo
Publication Date
2016-02-16Journal Title
British Journal of Cancer
ISSN
0007-0920
Publisher
Nature Publishing Group
Pages
381-387
Language
English
Type
Article
Metadata
Show full item recordCitation
Janowitz, T., Thuss-Patience, P., Marshall, A., Kang, J. H., Connell, C., Cook, N., Dunn, J., et al. (2016). Chemotherapy versus Supportive Care Alone for Relapsed Gastric, Gastroesophageal Junction and Oesophageal Adenocarcinoma: a Meta-analysis of Patient Level Data. British Journal of Cancer, 381-387. https://doi.org/10.1038/bjc.2015.452
Abstract
BACKGROUND
Second line chemotherapy treatment of patients with relapsed gastric and oesophageal cancers in comparison with supportive care alone has been supported by recent phase 3 clinical trials, but a meta-analysis of patient level data is lacking.
METHODS
We searched Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and the Web of Science TM for phase 3 clinical trials that compared second line chemotherapy with supportive care alone for gastric and oesophageal cancers. A meta-analysis of the comprehensive patient level data from the three identified trials was performed.
RESULTS
A total of 410 patients with gastric (n=301), gastroesophageal junction (n=76) or oesophageal (n=33) adenocarcinoma were identified. 154 patients received single agent docetaxel and 84 patients single agent irinotecan, each with supportive care. Supportive care alone was given to 172 patients. Chemotherapy significantly reduced the risk of death (HR=0.63, 95% CI 0.51-0.77, p<0.0001). This effect was observed for treatment with docetaxel (HR=0.71, 95% CI 0.56-0.89, p=0.003) and irinotecan (HR=0.49, 95% 0.36-0.67, p<0.001). Overall survival benefit was greatest for patients who prog ressed 3-6 months following first line chemotherapy (HR=0.39, 95% CI 0.26-0.59, P<0.0001). Performance status (PS) 0-1 compared with PS 2 (HR=0.66, 95% CI 0.46-0.94, p=0.02), locally advanced disease compared with metastatic disease (HR=0.41, 95% CI 0.25-0.67, p=0.0004) and older age (HR=0.94 per 5 years, 95% CI 0.90-0.99, p=0.01) were significant predictors of improved overall survival. Progression of disease during first line treatment (HR=1.24, 95% CI 0.96- 1.59) or within the first 3 months of completion of first line treatment (HR=1.42, 95% CI 1.09-1.83) were predictors of an increased risk of death compared with progression between 3 and 6 months (p=0.03). Health-related quality of life (HRQoL) outcomes were reported in only one of the three trials, precluding meta-analysis of these parameters.
CONCLUSION
This meta-analysis of patient level data confirms that second line chemotherapy treatment results in significantly better overall survival co mpared with supportive care alone in patients with platinum and fluoropyrimidine refract ory gastric and oesphageal adenocarcinoma. HRQoL outcomes should be included in future trials in this setting.
Keywords
gastric cancer, oesophagogastric cancer, oesophageal cancer, meta-analysis, second line chemotherapy, patient level data, active symptom control, best supportive care, docetaxel, irinotecan, age
Sponsorship
TJ and CC were supported by the Wellcome Trust Translational Medicine and Therapeutics programme and the National Institute for Health Research.
Identifiers
External DOI: https://doi.org/10.1038/bjc.2015.452
This record's URL: https://www.repository.cam.ac.uk/handle/1810/252870
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