Original article Survival analysis of platinum-refractory patients with advanced esophageal cancer treated with docetaxel or best supportive care alone: a retrospective study T. Moriwaki, 1 T. Kajiwara, 2 T. Matsumoto, 2 H. Suzuki, 1 Y. Hiroshima, 1 K. Matsuda, 1 S. Hirai, 1 Y. Yamamoto, 1 T. Yamada, 1 A. Sugaya, 1 M. Kobayashi, 1 S. Endo, 1 K. Ishige, 1 T. Nishina 2 , I. Hyodo 1 1 Division of Gastroenterology, University of Tsukuba, Tsukuba, 2 Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan SUMMARY. The survival benefit of second-line chemotherapy with docetaxel in platinum-refractory patients with advanced esophageal cancer (AEC) remains unclear. A retrospective analysis of AEC patients with Eastern Cooperative Oncology Group performance status (PS) ≤ 2 was performed, and major organ functions were preserved, who determined to receive docetaxel or best supportive care (BSC) alone after failure of platinum-based chemotherapy. The post-progression survival (PPS), defined as survival time after disease progression following platinum-based chemotherapy, was analyzed by multivariate Cox regression analysis using factors identified as significant in univariate analysis of various 20 characteristics (age, sex, PS, primary tumor location, etc) including Glasgow prognostic score (GPS), which is a well-known prognostic factor in many malignant tumors. Sixty-six and 45 patients were determined to receive docetaxel and BSC between January 2007 and December 2011, respectively. The median PPS was 5.4 months (95% confidence interval [CI] 4.8–6.0) in the docetaxel group and 3.3 months (95% CI 2.5–4.0) in the BSC group (hazard ratio [HR] 0.56, 95% CI 0.38–0.84, P = 0.005). Univariate analysis revealed six significant factors: treatment, PS, GPS, number of metastatic organs, liver metastasis, and bone metastasis. Multivariate analysis including these significant factors revealed three independent prognostic factors: docetaxel treatment (HR 0.62, 95% CI 0.39–0.99, P = 0.043), better GPS (HR 0.61, 95% CI 0.46–0.81, P = 0.001), and no bone metastasis (HR 0.31, 95% CI 0.15–0.68, P = 0.003). There was a trend for PPS in favor of the docetaxel group compared with patients who refused docetaxel treatment in the BSC group (adjusted HR 0.61, 95% CI 0.29–1.29, P = 0.20). Docetaxel treatment may have prolonged survival in platinum-refractory patients with AEC. KEY WORDS: best supportive care, docetaxel, esophageal cancer, Glasgow prognostic score, platinum-refractory. INTRODUCTION Esophageal cancer is an aggressive disease with a high mortality and is the sixth most common cause of cancer-related deaths worldwide. 1 The incidence of adenocarcinoma has increased rapidly in Western countries, reflecting increases in obesity, gastro- esophageal reflux disease, and Barrett’s esophagus, although squamous cell carcinoma still accounts for over 95% of esophageal cancers in Asian countries. 2 Patients with unresectable or recurrent esophageal cancer have a very poor prognosis and require palliative therapies, including chemotherapy, exter- nal beam radiotherapy, and placement of a self- expanding metal stent. 5-Fluorouracil (5-FU) plus cisplatin (CDDP) is the standard chemotherapy in this palliative setting, 3–5 but the optimal second-line chemotherapy has not been established. 6 Taxane- based (docetaxel or paclitaxel) second-line chemo- therapy has been investigated in several phase II studies. 7–15 These studies demonstrated some activi- ties of chemotherapy, and docetaxel alone has com- monly been used in clinical practice, despite no robust evidence for survival benefit in the randomized, con- trolled trial. The numbers of patients in the studies Address correspondence to: Dr Toshikazu Moriwaki, PhD, MD, Division of Gastroenterology, University of Tsukuba, Tennodai 1-1-1, Tsukuba, Ibaraki 305-0006, Japan. Email: tmoriwak@gmail.com Financial support: This study was not supported by any sponsor or funding agency. Conflicts of interest: The authors have declared no conflicts of interest. Diseases of the Esophagus (2014) ••, ••–•• DOI: 10.1111/dote.12246 © 2014 International Society for Diseases of the Esophagus 1