Poster Presentation COSA 2015 ASM

‘Rethinking REAL-2: Real-life outcomes from an Australian retrospective audit of patients with metastatic oesophago-gastric adenocarcinoma (mOGC)’ (#219)

Claudia E.A Stretch 1 , David L Chan 1 , Nick Pavlakis 1 , Connie Diakos 1 , Kazi Nahar 1 , Malinda Itchins 1 , Steven Leibman 2 , Garett Smith 2 , Stephen Clarke 1
  1. Oncology Department, Royal North Shore Hospital, Sydney, NSW, Australia
  2. Upper Gastrointestinal Surgery Department, Royal North Shore Hospital, Sydney, NSW, Australia

Aims

Triplet epirubicin-containing chemotherapy is commonly used in the treatment of metastatic gastro-oesophageal adenocarcinoma. A trial comparing different triplet regimens showed no difference in outcome or toxicity rates comparing use of oxaliplatin/cisplatin and 5-fluorouracil/capecitabine. We aimed to compare survival and toxicity in an Australian cohort against the trial population, and examine the impact of patient factors or regimen choice on these outcomes.

Methods

We performed a retrospective audit to identify patients diagnosed with mOGC in three oncology centres in Sydney from 2011-2014. Endpoints were overall survival and incidence of any toxicity as well as hospitalization during chemotherapy. Subgroup analyses were performed using log-rank test, comparing “non-trial” candidates (age over 70, prior chemotherapy, concurrent malignancy) to “trial” candidates, and comparing patients receiving 5-FU versus capecitabine.

Results

22 patients were eligible for analysis. The median overall survival was 10.3 months. All patients reported side effects during treatment.

12 patients met “trial” criteria and 10 did not. Trial-like patients had a median survival of 10.5 months versus 8.5 months for non-trial-like patients (HR 0.81, 95% CI 0.29-2.25, p=0.25). Seven of 12 trial-like patients were admitted (58%) compared to 7/10 non-trial-like patients (70%) (p=0.67, Fisher’s exact test).

6 patients received infusional 5-FU and 16 capecitabine. Infusional 5-FU patients had a median survival of 12.1 months versus 8.3 months for capecitabine (HR 0.68, 95% CI 0.25-1.90, p=0.58). Two of six 5-FU patients (33%) were admitted compared to 12/16 capecitabine patients (75%) (p=0.14, Fisher’s exact test). Cisplatin-oxaliplatin comparisons were not performed as only 1 patient received oxaliplatin.

Conclusion

Our cohort of patients with mOGC demonstrated similar survival to that in the REAL-2 trial1. We note significant rates of toxicity regardless of age, prior chemotherapy or choice of regimen. Triplet chemotherapy should continue to be offered to patients with mOGC, with low threshold to dose reduction.

  1. Cunningham, D. et al. (2008), Capecitabine and oxaliplatin for advanced esophagogastric cancer., N Engl J Med. 358(1):36-46.