Second-line palliative systemic treatment for synchronous metastatic esophagogastric cancer: a population-based study

Date 29 September 2019
Event ESMO 2019 Congress
Session Poster Display session 2
Topics Oesophageal Cancer
Gastric Cancer
Presenter Willemieke Dijksterhuis
Citation Annals of Oncology (2019) 30 (suppl_5): v253-v324. 10.1093/annonc/mdz247
Authors W.P.M. Dijksterhuis1, R.H.A. Verhoeven2, M. Slingerland3, N. Haj Mohammad4, J. de Vos-Geelen5, L.V. Beerepoot6, T. Van Voorthuizen7, G. Creemers8, M. van Oijen1, H.W.M. van Laarhoven1
  • 1Medical Oncology, Amsterdam UMC, 1105AZ - Amsterdam/NL
  • 2Epidemiology, Netherlands Comprehensive Cancer Organization (IKNL), 5612HZ - Eindhoven/NL
  • 3Medical Oncology, Leids Universitair Medisch Centrum (LUMC), 2333 ZA - Leiden/NL
  • 4Medical Oncology, University Medical Center Utrecht, Utrecht/NL
  • 5Medical Oncology, Maastricht University Medical Center (MUMC), 6202 AZ - Maastricht/NL
  • 6Medical Oncology, Elisabeth-TweeSteden Hospital, 5022 GC - Tilburg/NL
  • 7Medical Oncology, Rijnstate Hospital, 6900 - Arnhem/NL
  • 8Medical Oncology, Catharina Hospital Eindhoven, 5602 ZA - Eindhoven/NL



Metastatic esophagogastric cancer patients can be treated with paclitaxel/ramucirumab, or another taxane, or an irinotecan-containing regimen in second line. The aim of this study was to explore the real-world use of second-line palliative systemic treatment in esophagogastric cancer and to compare treatment regimens in terms of overall survival (OS) and time to failure of second-line treatment (TTF).


Synchronous metastatic esophagogastric cancer patients treated with systemic therapy (2010-2015) were selected from the nationwide Netherlands Cancer Registry. Systemic treatment was considered second line if a drug group was used that essentially differed from first-line treatment, irrespective of reason for switch of treatment. Thus, a switch from capecitabine/oxaliplatin (CapOx) to docetaxel was considered second line, while CapOx to i.v. 5-fluorouracil (5-FU)/oxaliplatin was not. OS and TTF were calculated from start of second-line treatment until date of death, or progression/failure of treatment, and analyzed using Kaplan Meier curves with logrank test.


Second-line systemic treatment was applied in 344 (20%) of the 1712 patients that received first-line systemic treatment in 2010-2015, of which 96% had adenocarcinoma and 4% squamous cell carcinoma. In the total cohort, 38 different second-line systemic treatment regimens were administered. Monotherapy with a taxane (31%), paclitaxel/ramucirumab (13%), carboplatin/paclitaxel (10%), trastuzumab-containing regimens (7%), fluoropyrimidine/platinum doublets (7%), irinotecan (6%), and 5-FU/irinotecan (6%) were most frequently used regimens. In patients that received second-line treatment, median OS was 5.2 (IQR 2.7, 8.6) and TTF 2.8 (IQR 1.5, 5.0) months. Median OS was 3.9 (IQR 2.3, 6.4) months in patients treated with second-line taxane monotherapy (n = 108), and 5.4 (IQR 2.3, 9.7) months in patients treated with paclitaxel/ramucirumab (n = 45, p = 0.188).


According to real-world evidence, 20% of synchronous metastatic esophagogastric cancer patients treated with first-line systemic therapy receive second-line systemic treatment, most frequently consisting of a taxane with or without ramucirumab.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

The authors.




R.H.A. Verhoeven: Research grant / Funding (institution): Roche; Research grant / Funding (institution): BMS. N. Haj Mohammad: Advisory / Consultancy: BMS; Advisory / Consultancy: MSD. J. de Vos-Geelen: Non-remunerated activity/ies: BTG; Research grant / Funding (institution), Non-remunerated activity/ies: Servier; Advisory / Consultancy: Shire. T. Van Voorthuizen: Non-remunerated activity/ies: Astellas; Non-remunerated activity/ies: Ipsen; Non-remunerated activity/ies: Roche; Non-remunerated activity/ies: Bayer. M. van Oijen: Research grant / Funding (institution): Lilly; Research grant / Funding (institution): Nordic; Research grant / Funding (institution): Merck Serono; Research grant / Funding (institution): Servier; Research grant / Funding (institution): Amgen; Research grant / Funding (institution): Roche. H.W.M. van Laarhoven: Research grant / Funding (institution): Bayer; Advisory / Consultancy, Research grant / Funding (institution): BMS; Advisory / Consultancy, Research grant / Funding (institution): Celgene; Advisory / Consultancy, Research grant / Funding (institution): Lilly; Research grant / Funding (institution): Merck Serono; Research grant / Funding (institution): MSD; Advisory / Consultancy, Research grant / Funding (institution): Nordic; Research grant / Funding (institution): Philips; Research grant / Funding (institution): Roche. All other authors have declared no conflicts of interest.