The BC Cancer Agency Compassionate Access Program: Outcome analysis of patients with esophagogastric cancer

Abstract

Background: The BC Cancer Agency Gastro-intestinal Tumor Group supports one standard of care (soc) chemotherapy regimen for metastatic esophagogastric adenocarcinoma - specifically, weekly cisplatin and 5-fluorouracil (5FU) infusion. All other regimens require Compassionate Access Program (CAP) approval for public funding. Objectives: We examined response, toxicity, and survival after first-line CAP chemotherapy (CAP1), or soc and second-line CAP chemotherapy (CAP2). Patients and Methods: We searched CAP records for December 1999 to April 2006, abstracted charts, constructed a database, and undertook survival analyses. Treatment response, serious toxicities, and hospitalizations were recorded. Results: We identified 32 esophageal (10 gastroesophageal junction) and 53 gastric cancer (62%) patients, 55 of whom were stage M1 at diagnosis. Prior therapy consisted of chemoradiotherapy (n = 14), adjuvant chemotherapy (n = 3), and radical surgery (n = 34). Of these 85 patients, 50 received CAP1, and 35 received soc, then CAP2. Docetaxel and irinotecan regimens accounted for 34% and 36%, 5% and 55%, 16% and 32% respectively of first-, second-, and third-line CAP requests. Partial responses were documented with soc (11/35, 31%) and CAP1 (6/50, 12%). Grade 3+ toxicity rates were 19/50 (38%) and 6/35 (17%) with CAP1 and soc chemotherapy. With CAP chemotherapy, 20 hospitalizations occurred, and with soc chemotherapy, 2 hospitalizations. For all patients, median follow-up and survival times were 8.9 months and 9.7 months respectively. Limitations: This is a retrospective analysis of patients deemed suitable to receive non-soc chemotherapy regimens or unsuitable to receive soc chemotherapy. Conclusions: Toxicities in CAP chemotherapy regimens were substantial. Survival times were consistent with results of international phase II and III trials in esophagogastric cancer. Copyright © 2009 Multimed Inc.