Impact of sequential lines of palliative chemotherapy in patients with recurrent/metastatic esophageal squamous cell carcinoma : A retrospective analysis of 107 patients in a single center

Abstract

Background: Effective, tolerable treatment options are limited in case of recurrent/metastatic esophageal squamous cell carcinoma (ESCC). Efficacy data for palliative chemotherapy by the lines of chemotherapy are limited. We retrospectively analyzed progression-free survival (PFS) for each line of chemotherapy. Materials and Methods: All 107 patients who began palliative chemotherapy at the Asan Medical Center for recurrent/metastatic ESCC from March 2015 to October 2017 were included, and grouped according to previous curative treatment; Groups A (previous chemoradiation alone, n=30), B (previous surgery alone, n=11), C (previous chemoradiation and surgery, n=30), and D (initially metastatic or de novo stage IV, n=36). Groups A, B, C (n=71(30+11+30); pretreated group) and Group D (n=36; treatment-naïve group) were reorganized according to treatment history. Overall response rate (ORR) and survival data were evaluated for each group, line of chemotherapy and chemotherapeutic regimen. Results: Baseline characteristics of the pretreated and treatment-naive groups were comparable (exceptions: distant metastasis and TNM stage). ORR were 25.2%, 7.3%, and 3.4% in 1st, 2nd, and 3rd-line chemotherapy, respectively. Median PFS was 4.7, 2.0 and 2.2 months in 1st, 2nd, 3rd-line chemotherapy, respectively. The median OS (10.1 [95% CI, 7.3-12.9] months) was not significantly different between pretreated and treatment-naive groups (p=0.88). Previous surgery, good performance, ≥ 3 lines of chemotherapy, and low C-reactive protein level were linked to a significantly longer OS in multivariate analysis. Conclusion: PFS declined rapidly with progress of lines of palliative chemotherapy. OS in treatment-naïve and pretreated groups was not significantly different. If tolerable, continuing advanced lines of chemotherapy may have survival benefit.