CC BY-NC-ND 4.0 · Indian J Med Paediatr Oncol 2018; 39(01): 46-51
DOI: 10.4103/ijmpo.ijmpo_39_17
Original Article

Outcomes with Palliative Weekly Paclitaxel in Advanced, Recurrent, and Metastatic Esophageal Cancer - Real World Experience

Amit Joshi
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Vanita Noronha
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Avinash Pandey
Department of Medical Oncology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
,
Vijay Patil
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Aseem Samar
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Abhishek Mahajan
Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Amit Janu
Department of Radio-Diagnosis, Tata Memorial Hospital, Mumbai, Maharashtra, India
,
Kumar Prabhash
Department of Medical Oncology, Tata Memorial Hospital, Mumbai, Maharashtra, India
› Author Affiliations
Financial support and sponsorship Nil.

Abstract

Background: In advanced esophageal cancer, combination chemotherapy regimens provide effective palliation but result in substantial toxicity. Aim: The aim of the study was to evaluate outcomes of recurrent and metastatic esophageal carcinoma treated with weekly paclitaxel. Objectives: The objective of the study was to determine the clinical and laboratory factors predicting response and affecting overall survival (OS) in patients receiving palliative chemotherapy for advanced esophageal/gastroesophageal cancer. Materials and Methods: Retrospective analysis of patients with advanced esophageal cancer, not amenable to definitive intent therapy that was treated with intravenous weekly paclitaxel was done. Progression-free survival (PFS) and OS were calculated with Kaplan–Meir analysis while factors affecting outcome were subjected to log rank test and multivariate analysis. Results: Between September 2010 and October 2014, 350 patients were included in analysis. Median follow-up is 8 months. Median age was 55 years, with a male:female ratio of 2.4:1. Nearly 34.5% were mid esophageal and 51% were lower third and gastroesophageal junction tumors. Almost 58% of the tumors had squamous histology. Performance status was >2 in 25.4%. Almost 62% patients had received prior therapy. Median number of cycles of weekly paclitaxel delivered was 12 with median duration of 3 months. Nearly 51% of patients had improvement in dysphagia, with time to symptom improvement of 20 days. In 31% patients, feeding nasogastric tube could be removed. Overall response rate was 32% (complete remission, 2.5% + partial remission, 29.5%). Median PFS was 4.0 months (95% confidence interval [CI]: 3.6–4.3 months) and median OS was 10 months (95% CI: 8.5–11.4 months). Performance status and pretreatment albumin significantly affected OS. Conclusion: Metronomic weekly paclitaxel chemotherapy provides good palliative benefit in advanced unresectable/metastatic esophageal cancer with minimal toxicity. Eastern Cooperative Oncology Group Performance Status (PS 0 and 1) and baseline serum albumin level >3.7 g/dl significantly improved survival.



Publication History

Article published online:
23 June 2021

© 2018. Indian Society of Medical and Paediatric Oncology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 
  • References

  • 1 Noronha V, Patil V, Bhosale B, Joshi A, Purandare N, Prabhash K. Metronomic weekly paclitaxel in advanced unresectable esophageal cancer. Indian J Cancer 2013; 50: 128-34
  • 2 Van CutsemE, Moiseyenko VM, Tjulandin S, Majlis A, Constenla A, Boni C. et al Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V325 Study Group. J Clin Oncol 2006; 24: 4991-7
  • 3 Webb A, Cunningham D, Scarffe JH, Harper P, Norman A, Joffe JK. et al. Randomized trial comparing epirubicin, cisplatin, and fluorouracil versus fluorouracil, doxorubicin, and methotrexate in advanced esophagogastric cancer. J Clin Oncol 1997; 15: 261-7
  • 4 Homs MY, Gaast A, Siersema PD, Steyerberg EW, Kuipers EJ. Chemotherapy for metastatic carcinoma of the esophagus and gastro-esophageal junction. The Cochrane database of systematic reviews 2006:Cd004063
  • 5 Williams A, Bryant A. Short versus long duration infusions of paclitaxel for any advanced adenocarcinoma. The Cochrane database of systematic reviews 2011:Cd003911.
  • 6 Malkan G, Mohandas KM. Epidemiology of digestive cancers in India.I General principles and esophageal cancer. Indian J Gastroenterol 1997; 16: 98-102
  • 7 Yeole BB, Kurkure AP, Sunny L. Cancer survival in Mumbai (Bombay), India, 1992-1999 IARC scientific publications 2011; 133-42
  • 8 Grünberger B, Raderer M, Schmidinger M, Hejna M. Palliative chemotherapy for recurrent and metastatic esophageal cancer. Anticancer Res 2007; 27: 2705-14
  • 9 Chau I, Norman AR, Cunningham D, Oates J, Hawkins R, Iveson T. et al. The impact of primary tumour origins in patients with advanced oesophageal, oesophago-gastric junction and gastric adenocarcinoma – Individual patient data from 1775 patients in four randomised controlled trials. Ann Oncol 2009; 20: 885-91
  • 10 Wang K, Johnson A, Ali SM, Klempner SJ, Bekaii-Saab T, Vacirca JL. et al. Comprehensive genomic profiling of advanced esophageal squamous cell carcinomas and esophageal adenocarcinomas reveals similarities and differences. Oncologist 2015; 20: 1132-9
  • 11 Ilson DH. Docetaxel, cisplatin, and fluorouracil in gastric cancer: Does the punishment fit the crime?. J Clin Oncol 2007; 25: 3188-90
  • 12 Muro K, Hamaguchi T, Ohtsu A, Boku N, Chin K, Hyodo I. et al. A phase II study of single-agent docetaxel in patients with metastatic esophageal cancer. Ann Oncol 2004; 15: 955-9
  • 13 Wagner AD, Grothe W, Haerting J, Kleber G, Grothey A, Fleig WE. Chemotherapy in advanced gastric cancer: A systematic review and meta-analysis based on aggregate data. J Clin Oncol 2006; 24: 2903-9
  • 14 Ilson DH, Wadleigh RG, Leichman LP, Kelsen DP. Paclitaxel given by a weekly 1-h infusion in advanced esophageal cancer. Ann Oncol 2007; 18: 898-902
  • 15 Kato K, Tahara M, Hironaka S, Muro K, Takiuchi H, Hamamoto Y. et al. A phase II study of paclitaxel by weekly 1-h infusion for advanced or recurrent esophageal cancer in patients who had previously received platinum-based chemotherapy. Cancer Chemother Pharmacol 2011; 67: 1265-72
  • 16 Murad AM, Santiago FF, Petroianu A, Rocha PR, Rodrigues MA, Rausch M. Modified therapy with 5-fluorouracil, doxorubicin, and methotrexate in advanced gastric cancer. Cancer 1993; 72: 37-41
  • 17 Pyrhönen S, Kuitunen T, Nyandoto P, Kouri M. Randomised comparison of fluorouracil, epidoxorubicin and methotrexate (FEMTX) plus supportive care with supportive care alone in patients with non-resectable gastric cancer. Br J Cancer 1995; 71: 587-91
  • 18 Glimelius B, Ekström K, Hoffman K, Graf W, Sjödén PO, Haglund U. et al Randomized comparison between chemotherapy plus best supportive care with best supportive care in advanced gastric cancer. Ann Oncol 1997; 8: 163-8
  • 19 Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K. et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer-a randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). European journal of cancer (Oxford, England: 1990) 2011; 47: 2306-14
  • 20 Wagner AD, Unverzagt S, Grothe W, Kleber G, Grothey A, Haerting J. et al. Chemotherapy for advanced gastric cancer. Cochrane Database Syst Rev 2010:Cd004064
  • 21 Kang JH, Lee SI, Lim DH, Park KW, Oh SY, Kwon HC. et al. Salvage chemotherapy for pretreated gastric cancer: A randomized phase III trial comparing chemotherapy plus best supportive care with best supportive care alone. J Clin Oncol 2012; 30: 1513-8
  • 22 Thuss-Patience PC, Kretzschmar A, Bichev D, Deist T, Hinke A, Breithaupt K. et al. Survival advantage for irinotecan versus best supportive care as second-line chemotherapy in gastric cancer – A randomised phase III study of the Arbeitsgemeinschaft Internistische Onkologie (AIO). Eur J Cancer 2011; 47: 2306-14
  • 23 Ford HE, Marshall A, Bridgewater JA, Janowitz T, Coxon FY, Wadsley J. et al. Docetaxel versus active symptom control for refractory oesophagogastric adenocarcinoma (COUGAR-02): An open-label, phase 3 randomised controlled trial. Lancet Oncol 2014; 15: 78-86
  • 24 Janowitz T, Thuss-Patience P, Marshall A, Kang JH, Connell C, Cook N. et al. Chemotherapy vs supportive care alone for relapsed gastric, gastroesophageal junction, and oesophageal adenocarcinoma: A meta-analysis of patient-level data. Br J Cancer 2016; 114: 381-7
  • 25 Higuchi K, Tanabe S, Shimada K, Hosaka H, Sasaki E, Nakayama N. et al. Biweekly irinotecan plus cisplatin versus irinotecan alone as second-line treatment for advanced gastric cancer: A randomised phase III trial (TCOG GI-0801/BIRIP trial). Eur J Cancer 2014; 50: 1437-45
  • 26 Nishikawa K, Fujitani K, Inagaki H, Akamaru Y, Tokunaga S, Takagi M. et al. Randomised phase III trial of second-line irinotecan plus cisplatin versus irinotecan alone in patients with advanced gastric cancer refractory to S-1 monotherapy: TRICS trial. Eur J Cancer 2015; 51: 808-16
  • 27 Sym SJ, Hong J, Park J, Cho EK, Lee JH, Park YH. et al. A randomized phase II study of biweekly irinotecan monotherapy or a combination of irinotecan plus 5-fluorouracil/leucovorin (mFOLFIRI) in patients with metastatic gastric adenocarcinoma refractory to or progressive after first-line chemotherapy. Cancer Chemother Pharmacol 2013; 71: 481-8