title: Rechallenge with platinum plus fluoropyrimidine +/- epirubicin in patients with oesophagogastric cancer.
abstract: OBJECTIVE
  There is no standard second-line therapy for patients with oesophagogastric cancer who progress following first-line chemotherapy for advanced disease or relapse following radical multi-modality therapy. The aim of this retrospective study was to evaluate survival following rechallenge with platinum plus fluoropyrimidine (PF) +/- epirubicin.
  
  
  METHODS
  Patients treated with PF +/- epirubicin for oesophagogastric cancer at our institution were identified from the electronic prescribing database. Patients rechallenged with PF +/- epirubicin >3 months after completing initial chemotherapy were eligible. Primary endpoint was survival, calculated from day 1 of rechallenge treatment to date of death or last follow-up. Secondary endpoints were progression-free survival and response rate to PF-based re-challenge.
  
  
  RESULTS
  Between 2000 and 2008, 950 patients treated with PF +/- epirubicin for oesophagogastric cancer were identified. 298 patients progressed or relapsed >3 months after completing chemotherapy, of whom 106 patients were rechallenged with PF-based chemotherapy. Median progression-free survival and overall survival were 5.1 and 10 months, respectively, from date of rechallenge for patients treated with initial radical intent and 3.9 and 6.6 months, respectively, in patients treated with palliative intent from diagnosis. In a survival analysis, no significant prognostic factors were identified.
  
  
  CONCLUSIONS
  Selected patients with oesophagogastric cancer who relapse or progress >3 months after initial treatment with PF +/- epirubicin may benefit from re-introduction of PF-based chemotherapy.
authors.affiliation: Department of Medicine, The Royal Marsden Hospital, London, UK. david.cunningham@rmh.nhs.uk
authors.forename: A F C
authors.initials: AF
authors.lastname: Okines
authors.forename: U
authors.initials: U
authors.lastname: Asghar
authors.forename: D
authors.initials: D
authors.lastname: Cunningham
authors.forename: S
authors.initials: S
authors.lastname: Ashley
authors.forename: J
authors.initials: J
authors.lastname: Ashton
authors.forename: K
authors.initials: K
authors.lastname: Jackson
authors.forename: E
authors.initials: E
authors.lastname: Hawkes
authors.forename: I
authors.initials: I
authors.lastname: Chau
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000328:Adult; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D015251:Epirubicin / Q000008:administration & dosage; D004938:Esophageal Neoplasms / Q000188:drug therapy*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010166:Palliative Care / Q000379:methods; D017671:Platinum Compounds / Q000008:administration & dosage; D011743:Pyrimidines / Q000008:administration & dosage; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D017671:Platinum Compounds; D011743:Pyrimidines; D015251:Epirubicin