Abstract
Most patients with gastric or gastroesophageal junction (gej) cancer are diagnosed with inoperable advanced or metastatic disease. In these cases, chemotherapy is the only treatment demonstrating survival benefit. The present study compares clinicopathologic characteristics and survival outcomes for patients with advanced esophageal, gej, and gastric adenocarcinoma treated with first-line chemotherapy [epirubicin-cisplatin-5-fluorouracil (ecf), epirubicin-cisplatin-capecitabine (ecx), or etoposide-leucovorin-5-fluorouracil (elf)] or best supportive care (bsc) at our institution with those for historical controls. We retrospectively reviewed medical information for 401 patients with newly diagnosed advanced esophageal, gej, or gastric adenocarcinoma treated with first-line chemotherapy (ecf, ecx, or elf) or bsc from January 1, 2004, through December 31, 2010. Descriptive statistics were used to compare the data collected with data for historical control patients. Of the study patients, 93% were diagnosed with metastatic disease (n = 374), and 63% received bsc only (n = 251). The main reasons that patients received bsc only included poor Eastern Cooperative Oncology Group performance status (55%), patient decision (31%), and comorbidities (14%). Of the remaining patients, 98 (24%) received ecf or ecx and 52 (13%) received elf as first-line treatment. Median overall survival was significantly longer in patients treated with ecf or ecx or with elf than in those receiving bsc (12.7 months vs. 12.7 months vs. 5.5 months respectively). Chemotherapy also significantly reduced the risk of death (64% reduction with ecf or ecx, 58% with elf). We confirmed the substantial overall survival benefit of combination chemotherapy compared with bsc, with better survival in our patient population than in historical controls. However, novel treatment options are still warranted to improve outcomes in this patient population.
Highlights
Gastric cancer is the fourth most common malignancy and the second leading cause of cancer-related death worldwide, with 989,000 new cases and 738,000 deaths occurring annually[1]
We retrospectively reviewed medical information for 401 patients with newly diagnosed advanced esophageal, gej, or gastric adenocarcinoma treated with first-line chemotherapy or bsc from January 1, 2004, through December 31, 2010
We confirmed the substantial overall survival benefit of combination chemotherapy compared with bsc, with better survival in our patient population than in historical controls
Summary
Gastric cancer is the fourth most common malignancy and the second leading cause of cancer-related death worldwide, with 989,000 new cases and 738,000 deaths occurring annually[1]. Most esophageal malignancies are classified as either squamous cell carcinoma or adenocarcinoma, with the latter subtype emerging as the more common in developed countries. Most patients with gastric or gastroesophageal junction (gej) cancer are diagnosed with inoperable advanced or metastatic disease. In such cases, chemotherapy is the only treatment demonstrating survival benefit, with a 63% reduction in the risk of death in comparison to best supportive care (bsc), while improving overall quality of life[3]. There is no globally standardized regimen, fluoropyrimidine and platinum combinations form the backbone of chemotherapy for patients with advanced disease. Compared with doublet combinations, the addition of an anthracycline or a taxane to a fluoropyrimidine and platinum agent significantly improves overall survival (os)[3,4]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
