Hugo Ford, MD, director of cancer services at Addenbrooke’s Hospital in Cambridge, UK, describes selecting patients with metastatic esophagogastric cancer who will derive the greatest benefit from second-line treatment with docetaxel.

In the COURGAR-02 trial, 168 patients with advanced esophagogastric adenocarcinoma were evenly randomized to receive second-line docetaxel or active symptom control. Overall, patients with gastroesophageal junction cancer, performance status (PS) 0, and those with a longer duration since their last treatment experienced the most substantial benefits from second-line docetaxel.

Ford notes that approximately 70% of patients on the trial were assessed as PS2 and would not normally be considered for treatment with additional chemotherapy. However, PS2 status patients who tolerated treatment had a similar prognosis to patients with PS1 status. In general, Ford believes, a PS1 patient would normally be a candidate for second-line chemotherapy.

The take home message here, Ford believes, is that PS2 patients benefit from treatment when tolerated. These patients should be considered for a reduced dose and a more detailed discussion on the risks and benefits of treatment.

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Hugo Ford, MD, from the Addenbrooke's Hospital in Cambridge, UK, describes which patients with metastatic esophagogastric cancer derive the greatest benefit from second-line treatment with docetaxel.

Dr. Ford on Docetaxel in Esophagogastric Cancer

Hugo Ford, MD, director of cancer services at Addenbrooke’s Hospital in Cambridge, UK, describes results from the phase III COUGAR-02 study that examined second-line docetaxel in patients with advanced gastroesophageal adenocarcinoma.

Over the course of 4 years, the COUGAR-02 trial enrolled 168 patients who had progressed within 6 months on the standard first-line chemotherapy for advanced or metastatic gastroesophageal adenocarcinoma. These patients were randomized 1:1 to receive docetaxel at 75 mg/m

 every 3 weeks for up to 6 cycles or active symptom control, which could include radiotherapy, steroids, and supportive medications.

Due to the poor prognosis in this group of patients, only 23% of patients completed the full 6 cycles of treatment with docetaxel, notes Ford. However, for patients treated with docetaxel, overall survival was extended to 5.2 months compared to 3.6 (HR = 0.67; 95% CI, 0.49-0.92; 

Ford notes that docetaxel was reasonably well tolerated with a 7% incidence of febrile neutropenia. However, 30% of patients discontinued docetaxel due to side effects such as lethargy, which Ford explains may have been disease and not treatment related.

View coverage from the 2013 GI Cancers Symposium

Hugo Ford, MD, from the Addenbrooke's Hospital in Cambridge, UK, describes results from the phase III COUGAR-02 study that examined second-line docetaxel in patients with advanced gastroesophageal adenocarcinoma.

Hugo Ford, MD

Articles

Dr. Ford on Docetaxel in Esophagogastric Cancer

Dr. Hugo Ford on the Phase III COUGAR-02 Study