title: Active salvage chemotherapy versus best supportive care for patients with recurrent or metastatic squamous cell carcinoma of the esophagus refractory or intolerable to fluorouracil, platinum, and taxane.
abstract: OBJECTIVE
  The survival benefit of chemotherapy (CTx) compared with best supportive care (BSC) is unclear in patients with recurrent or metastatic esophageal squamous cell carcinoma (R/M-ESCC) previously treated with fluorouracil (FU), platinum (PT), and taxane (TAX).
  
  
  METHODS
  The data of 283 consecutive patients with R/M-ESCC, who could not tolerate or whose tumor was refractory to all three agents (FU, PT, and TAX) between March 2003 and November 2014, were retrospectively reviewed. Patient selection criteria were as follows: age 20-75 years, performance status 0-2, and preserved organ function. Prognostic factors for overall survival (OS), defined as survival time from the last administration of all three agents, were analyzed using the Kaplan-Meier method and Cox proportional hazards model.
  
  
  RESULTS
  Of the 283 patients, 147 received BSC and 136 received CTx (PT-containing regimen 37, investigative new drugs 28, irinotecan-containing regimen 29, TAX alone 25, FU alone 16, others 4). Most patients' tumors were refractory to all three agents. The median OS of BSC and CTx patients was 4.2 and 7.8 months (hazard ratio 0.41; 95% confidence interval 0.31-0.54), respectively. Multivariate analysis with or without propensity score matching indicated that BSC, metastatic sites other than lung, liver, or bone, and hemoglobin <10 g/dL were associated with poor prognosis.
  
  
  CONCLUSIONS
  CTx might provide a survival benefit over BSC even for patients with R/M-ESCC who cannot tolerate or whose tumor is refractory to all three agents.
authors: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, Aichi, 464-8681, Japan. excell@hkg.odn.ne.jp.|Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan. excell@hkg.odn.ne.jp.
authors: Motoo
authors: M
authors: Nomura
authors: Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Kyoto, 104-0045, Japan.
authors: Satoru
authors: S
authors: Iwasa
authors: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonogakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Takahiro
authors: T
authors: Tsushima
authors: Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Kyoto, 104-0045, Japan.
authors: Ken
authors: K
authors: Kato
authors: Division of Gastrointestinal Oncology, Shizuoka Cancer Center, 1007 Shimonogakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
authors: Hirofumi
authors: H
authors: Yasui
authors: Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Kyoto, 104-0045, Japan.
authors: Narikazu
authors: N
authors: Boku
authors: Department of Therapeutic Oncology, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
authors: Manabu
authors: M
authors: Muto
authors: Department of Clinical Oncology, Aichi Cancer Center Hospital, 1-1 Kanokoden Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
authors: Kei
authors: K
authors: Muro
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000401:mortality; D000077277:Esophageal Squamous Cell Carcinoma; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D012189:Retrospective Studies; D016879:Salvage Therapy
keywords: Best supportive care; Chemotherapy; Esophageal cancer; Metastasis