Evaluation of systemic second-line therapy in recurrent or metastatic esophageal cancer
Authors:   Department of Oncology-Radiotherapy, Prof. Dr Alexandru  Trestioreanu Institute of Oncology, Bucharest, Romania, Bacinschi Xenia E. ,   Carol Davila University of Medicine and Pharmacy, Bucharest,  Romania, Zgura Anca ,   Department of Oncology-Radiotherapy, Prof. Dr Alexandru  Trestioreanu Institute of Oncology, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest,  Romania, Stānuicā Monica I. ,   Department of Radiotherapy II, Prof. Dr Alexandru Trestioreanu Institute of Oncology, Bucharest, Romania, Iliescu Laura ,   Department of Internal Medicine II, Fundeni Clinical Institute,  Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest,  Romania, Anghel Rodica M. ,   Department of Oncology-Radiotherapy, Prof. Dr Alexandru  Trestioreanu Institute of Oncology, Bucharest, Romania; Carol Davila University of Medicine and Pharmacy, Bucharest,  Romania
Published: April 2022

Background: More than half of patients with locally advanced esophageal cancer are unresponsive to first-line chemotherapy. To date, there is no standard second-line regimen; new agents, such as immune-checkpoint inhibitors or anti-Neurotrophic Tropomyosin-Related Kinas agents, have only been recently recommended. This study aimed to assess the benefits of classical second-line chemotherapy in terms of survival and tolerance. Materials and Methods: This retrospective analysis assessed the benefits and tolerance of different second-line regimens of chemotherapy in progressive, locally advanced or metastatic oesophageal cancer treated at the department of Radiotherapy-Oncology at the Institute of Oncology between January 2011 and January 2017. Results: The analysis found 87 patient files with a median age 59.5 years (ranging between 41 and 84), of which 40.2% (35 patients) failed the first-line platinum and 5- fluorouracil combination. Histology favoured adenocarcinomas (63.2%). The patients were in good clinical condition, with ECOG 0–1 in 86.1% (74 patients), and less than five percent had more than three metastatic sites (3.4%, 3 patients). The regimens were mostly two-drug cytotoxic (53.9%, 47 patients): FOLFIRI in 18 patients (20.7%), FOLFOX in 18 patients (20.7%), vinorelbine–platinum combination in 11 patients (12.6%), and docetaxel in 40 patients (38.7%). The median treatment duration was 7.74 weeks (range 1 to 12). The general response rate was 47.1% (41 patients), including stable disease. The median time to progression was 7.61 weeks, with a range between 1.6 and 8.6 weeks, with no differences in this respect among the fourth type of treatment received (p = 0.170). Grade 3–4 toxicities, including neutropenia, gastrointestinal problems, and metabolic disorders, were observed in 44 patients (50.6%). The median event-free survival was 2 months (range between 1 and 6.3), and 63.2% (55 patients) subsequently received a third line of chemotherapy. Conclusion: Second-line chemotherapy is still the first-choice recommendation in all fit patients with advanced oesophageal cancer. The new agents are efficacious only in cases with PD-L1 positive or high microsatellite instability.