In a Chinese single-institution phase III trial reported in the Journal of Clinical Oncology, Lu et al found that early interdisciplinary supportive care with a focus on nutrition and psychological status was associated with improved overall survival vs standard care in previously untreated patients with metastatic esophagogastric cancer who were starting chemotherapy.

Study Details

In the open-label trial, 328 patients at Peking University Cancer Hospital & Institute were randomly assigned 2:1 between April 2015 and December 2017 to early interdisciplinary supportive care integrated with standard oncologic care (ESC group; n = 214) or standard oncologic care (SC group, n = 114). ESC was provided by a team of gastrointestinal medical oncologists, oncology nurse specialists, dietitians, and psychologists, with a focus on nutrition and psychological care. ESC patients had meetings with team members starting 14 days prior to initiating chemotherapy and every 3 weeks during treatment. Psychologists conducted individual and family psychotherapy and provided psychotropic interventions if necessary. SC patients were not scheduled for nutrition or psychology assessment, unless the patient or treating oncologist specifically requested such services. The primary endpoint was overall survival in the intention-to-treat population.

Key Findings

The groups did not significantly differ according to first-line chemotherapy regimens (cisplatin-, oxaliplatin-, or paclitaxel-based; triple- or single-drug).

The median number of cycles of first-line chemotherapy was five (interquartile range [IQR] = 4–7) in the ESC group vs four (IQR = 2-6) in the SC group. Objective response rates were 32% vs 27%.

At data cutoff in January 2019, median overall survival was 14.8 months (95% confidence interval [CI] = 13.3–16.3 months) in the ESC group vs 11.9 months (95% CI = 9.6–13.6 months) in the SC group (hazard ratio [HR] = 0.68, 95% CI = 0.51–0.9, P = .021).

In subgroup analysis, hazard ratios for overall survival were 0.76 (95% CI = 0.55–1.04) among 158 vs 88 patients with primary gastric cancer and 0.61 (95% CI = 0.34–1.09) among 56 vs 26 patients with primary esophageal cancer. Hazard ratios were 0.70 (95% CI = 0.51–0.97) among 153 vs 89 patients aged 65 or younger, and 0.82 (95% CI = 0.46–1.45) among 61 vs 25 older than 65.

Median progression-free survival was 5.1 months (95% CI = 4.7–6.4 months) in the ESC group vs 4.4 months (95% CI = 3.5–5.5 months) in the SC group (HR = 0.8, 95% CI = 0.62–1.04, P = .096).

Assessment with the EORTC Quality of Life Questionnaire (QLQ)-C30 showed a significant benefit in emotional functioning (P = .048) and cognitive functioning (P = .039) in the ESC group. Among 126 vs 62 patients with available data, weight loss occurred in 45% vs 58% of patients at week 9 (P = .032). Adverse events of any grade were reported in 89% vs 86% of patients.

The investigators concluded, “The early integration of interdisciplinary supportive care is an effective intervention with survival benefits for patients with metastatic esophagogastric cancer. Further optimization and standardization are warranted.”

Lin Shen, MD, PhD, Department of Gastrointestinal Oncology, and Lili Tang, MD, Department of Psycho-Oncology, Peking University Cancer Hospital & Institute, Beijing, are the corresponding authors for the Journal of Clinical Oncology article.

Disclosure: The study was supported by the National Key Research and Development Program of China and Beijing Municipal Science and Technology Commission Program. For full disclosures of the study authors, visit ascopubs.org.