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

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.