The BC Cancer Agency Compassionate Access Program: outcome analysis of patients with esophagogastric cancer

Abstract

Background: The BC Cancer Agency Gastro-intestinal Tumor Group supports one standard of care (SOC) chemotherapy regimen for metastatic esophagogastric adenocarcinoma-specifically, weekly cisplatin and 5-fluorouracil (5FU) infusion. All other regimens require Compassionate Access Program (CAP) approval for public funding.

Objectives: We examined response, toxicity, and survival after first-line cap chemotherapy (CAP1), or soc and second-line cap chemotherapy (CAP2).

Patients and methods: We searched cap records for December 1999 to April 2006, abstracted charts, constructed a database, and undertook survival analyses. Treatment response, serious toxicities, and hospitalizations were recorded.

Results: We identified 32 esophageal (10 gastroesophageal junction) and 53 gastric cancer (62%) patients, 55 of whom were stage M1 at diagnosis. Prior therapy consisted of chemoradiotherapy (n = 14), adjuvant chemotherapy (n = 3), and radical surgery (n = 34). Of these 85 patients, 50 received CAP1, and 35 received soc, then CAP2. Docetaxel and irinotecan regimens accounted for 34% and 36%, 5% and 55%, 16% and 32% respectively of first-, second-, and third-line cap requests. Partial responses were documented with soc (11/35, 31%) and CAP1 (6/50, 12%). Grade 3+ toxicity rates were 19/50 (38%) and 6/35 (17%) with CAP1 and soc chemotherapy. With cap chemotherapy, 20 hospitalizations occurred, and with soc chemotherapy, 2 hospitalizations. For all patients, median follow-up and survival times were 8.9 months and 9.7 months respectively.

Limitations: This is a retrospective analysis of patients deemed suitable to receive non-soc chemotherapy regimens or unsuitable to receive soc chemotherapy.

Conclusions: Toxicities in cap chemotherapy regimens were substantial. Survival times were consistent with results of international phase II and III trials in esophagogastric cancer.

Keywords: Esophagogastric adenocarcinoma; chemotherapy; survival; toxicity.

FIGURE 1

Kaplan–Meier analysis of overall survival by primary tumour site.

FIGURE 2

Kaplan–Meier analysis of overall survival (os), comparing cap1 with standard of care (soc ) and cap2 chemotherapy. Median os was 7.5 months (cap1) and 13.6 months (soc and cap2).