Dr. Ford on Docetaxel in Esophagogastric Cancer

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.