Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
Gewählte Publikation:
Mueller, M.
Benefits of palliative systemic second line therapy in locally advanced unresectable and metastatic esophageal squamous cell carcinoma
Humanmedizin; [ Diplomarbeit ] Medical University of Graz; 2021. pp. 88
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- Autor*innen der Med Uni Graz:
- Betreuer*innen:
- Gerger Armin
- Riedl Jakob
- Altmetrics:
- Abstract:
- Background: The level of evidence for established treatment regimens in the 2nd line therapy (2LTX) of advanced esophageal squamous cell carcinoma (aESCC) is limited. This is the first study that reports efficacy data comparing 2LTX versus active symptom control (ASC) in aESCC. Methods: We conducted a tri-centre retrospective cohort study (n=166), including all consecutively treated patients with aESCC who had experienced disease progression on palliative 1st line therapy (1LTX). A propensity score model using inverse-probability-of-treatment-weighting (IPTW) was implemented for comparative efficacy analysis of overall survival (OS) in patients with 2LTX+ASC versus ASC. Results: After progression on 1LTX, 74 (45%) patients were treated with ASC while 92 (55%) received 2LTX+ASC. The most frequent 2LTX regimens were docetaxel (36%) and paclitaxel (18%). In unadjusted analysis, 2LTX+ASC was associated with significantly longer OS compared to ASC only. However, patients in the 2LTX+ASC had a significantly higher prevalence of favourable prognostic factors such as better ECOG performance status, longer duration of 1LTX and lower baseline CRP levels. These imbalances could be fully removed by re-weighting the data with the IPTW. In the IPTW-adjusted analysis the favourable association between 2nd-line therapy and longer overall survival weakened but prevailed. The median OS was 6.1 months in the 2LTX group and 3.2 months in the ASC group, respectively (IPTW-adjusted Hazard ratio=0.40, 95%CI: 0.24-0.69, p=0.001). Importantly, the benefit of 2LTX was consistent across several clinical subgroups, including patients with ECOG performance status ≥1 and age ≥ 65. Conclusion: This real-world study supports the concept that 2LTX prolongs survival in patients with aESCC.