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Review

Cancer Research Frontiers. 2016 May; 2(2): 184-199. doi: 10.17980/2016.184

A Systematic Review of the Randomised Phase III Clinical Trials Employing Palliative Chemotherapy in the Management of Advanced Esophagogastric Adenocarcinoma

Amar M Eltweri1, Anne Thomas2, Ashley Dennison1,2, David Bowrey1,2*

1Department of Surgery, University Hospitals of Leicester, LE1 5WW, UK
2Department of Cancer Studies, University of Leicester, LE1 5WW, UK

 

*Corresponding author: Professor David Bowrey, Department of Surgery, Level 6 Balmoral Building, Leicester Royal Infirmary, LeicesterLE1 5WW, UK. Email: djb57@le.ac.uk. Tel: (+44) 0116 258 5247  Fax: (+44) 0116 258 6083

Citation: Amar Eltweri, et al. A Systematic Review of the Randomised Phase III Clinical Trials Employing Palliative Chemotherapy in the Management of Advanced Esophagogastric Adenocarcinoma. Cancer Research Frontiers. 2016 May; 2(2): 184-199. doi: 10.17980/2016.184

Copyright: @ 2016 Amar Eltweri, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Competing Interests: DJ Bowrey has received departmental grant support from Fresenius-Kabi and Nutricia for work unrelated to the current submission. AR Dennison has received departmental grant support from Fresenius-Kabi and Braun for work unrelated to the current submission. AM Eltweri has received departmental grant support from Fresenius-Kabi for work unrelated to the current submission. AL Thomas declares no competing interests.

Received Nov 2, 2015; Revised Feb 10, 2016; Accepted Mar 4, 2016. Published Apr 30, 2016

 

 

ABSTRACT

Background: Two-thirds of patients with esophagogastric cancer will be treated with palliative intent, with palliative chemotherapy being the most widely applied therapy. Just over half of those scheduled to receive this treatment will complete treatment as planned, with other patients failing to complete either because of disease progression or treatment side effects. The aim of this review was to report response rates, survival and toxicity of palliative chemotherapy for esophagogastric adenocarcinoma.

Methods: Forty-three randomised phase III clinical trials, reporting on 12,945 patients during the years indicate 1990-2016 were evaluated and information on response rate, survival and treatment related toxicity extracted. Thirty-three studies described patients receiving 1st line therapy and ten studies described patients receiving 2nd line therapy.

Results: Combination regimens were the most widely applied treatment worldwide as first line, with response rates in the order of 20-62%, and median overall survival in the order of 7.2-14.1 months. 30-85% of patients went on to receive second line therapy, generally single agent therapy, with reported response rates in the order of 7-22%, and median overall survival in the range 4.0-13.9 months. With the exception of trastuzumab, the effects of biological agents have been largely disappointing. The principal toxicities for chemotherapy were gastrointestinal (0-58%) and neutropenia (1-39% single agent, 12-82% combination therapy).

Conclusions: At the current time, combination therapy remains the standard of care for patients with advanced esophagogastric adenocarcinoma.

Keywords: adenocarcinoma esophagus; adenocarcinoma stomach; biological agents; chemotherapy; outcome measures; palliation

 

 

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