Background: The role of first and second-line palliative systemic chemotherapy is established in gastro-oesophageal cancer, but the survival benefits of subsequent-line and maintenance therapies are uncertain. This study explores these strategies in a cohort of patients in the ACT.
Method: A retrospective chart review was conducted of patients with metastatic gastro-oesophageal cancer in the ACT who commenced palliative systemic treatment between 1 January 2011 – 31 August 2017.
Results: Fifty-three patients who received first-line chemotherapy treatment were reviewed. Seven received maintenance treatment. Thirty-four patients received second-line treatment while 15 patients received subsequent-line treatment. Mean age at diagnosis was 63 years (range 38 – 86). Median progression-free survival (PFS) for maintenance capecitabine after first-line treatment was 10.8 months (95% CI 10.7 – 11.0) versus first-line treatment alone at 4.1 months (95% CI 2.9 – 5.3) (HR 0.321 [95% CI 0.133 – 0.774]; P = 0.008). Median overall survival was 21.7 months (95% CI 0.0 – 44.1) in the maintenance group of 7 patients as compared to 7.9 months (95% CI 6.5 – 9.2) in the non-maintenance group of 46 patients (HR 0.290 [95% CI 0.112 – 0.754]; P = 0.007). The maintenance group was favoured with a 71.0% (95% CI 37.7 – 100.0) 1-year survival rate and 43.0% (95% CI 5.8 – 80.2) 2-year survival rate as compared to 24.0% (95% CI 10.3 – 37.7) 1-year survival rate and 5.0% (95% 0.0 – 10.9) 2-year survival rate for the non-maintenance group (P = 0.012). There was no significant statistical difference in the median PFS found between third and second-line treatments (1.8 months; 95% CI 0.6 – 3.0 vs 2.2 months; 95% CI 1.5 – 2.9; HR 1.061 [95% CI 0.565 – 1.993]; P = 0.852).
Conclusions: Maintenance capecitabine could be prospectively evaluated in patients who have continued disease control after an adequate course of first-line combination treatment. Subsequent-line treatment had comparable survival benefits to second-line treatment.