Article type
Abstract
Background
Advanced esophageal cancer (EC) is a highly aggressive malignancy that poses significant challenges to patients and healthcare providers worldwide.
Objectives:
To comprehensively evaluate systemic oncological treatments (SOT) for advanced EC, examining their effectiveness, safety, and appropriateness based on existing evidence.
Methods
Part of the broader ASTAC-Study Project, this research aims to describe and assess evidence on the efficacy and appropriateness of anticancer drugs in advanced non-intestinal digestive cancers. EC, including the gastroesophageal junction, was the focal point. The project comprised three studies: Study 1 conducted an overview of systematic reviews; Study 2 critically assessed European clinical practice guidelines (CPGs); Study 3 conducted a scoping review and evidence map.
Results
Study 1 revealed uncertainty regarding whether SOT, including chemotherapy (CT), immunotherapy, biological, and targeted therapy, improves overall survival (OS) and progression-free survival (PFS) over conservative approaches. Most systematic reviews had critically low methodological quality and lacked important outcomes. Study 2 highlighted the low methodological quality of half of the published CPGs since 2010, with a lack of credible recommendations. Study 3 identified evidence on SOT efficacy and safety compared to best supportive care (BSC) for advanced gastroesophageal cancer, but diverse inclusion criteria and inadequate reporting led to heterogeneity in patient prognosis and control arm definition.
Conclusion
The available evidence for treating advanced EC patients lacks consistency, leading to discrepancies with recommendations by relevant CPGs. Potential bias may favor the overuse of anticancer drugs over BSC. High-quality research is urgently needed to understand SOT effectiveness versus BSC in managing advanced EC. Enhancing methodological precision, considering patient preferences, and addressing evidence gaps will contribute to informed clinical decision-making and improved patient outcomes.
https://doi.org/10.1186/s12885-021-08330-5
https://doi.org/10.1007/s12094-022-02807-w
https://onlinelibrary.wiley.com/doi/full/10.1111/jebm.12539.
Advanced esophageal cancer (EC) is a highly aggressive malignancy that poses significant challenges to patients and healthcare providers worldwide.
Objectives:
To comprehensively evaluate systemic oncological treatments (SOT) for advanced EC, examining their effectiveness, safety, and appropriateness based on existing evidence.
Methods
Part of the broader ASTAC-Study Project, this research aims to describe and assess evidence on the efficacy and appropriateness of anticancer drugs in advanced non-intestinal digestive cancers. EC, including the gastroesophageal junction, was the focal point. The project comprised three studies: Study 1 conducted an overview of systematic reviews; Study 2 critically assessed European clinical practice guidelines (CPGs); Study 3 conducted a scoping review and evidence map.
Results
Study 1 revealed uncertainty regarding whether SOT, including chemotherapy (CT), immunotherapy, biological, and targeted therapy, improves overall survival (OS) and progression-free survival (PFS) over conservative approaches. Most systematic reviews had critically low methodological quality and lacked important outcomes. Study 2 highlighted the low methodological quality of half of the published CPGs since 2010, with a lack of credible recommendations. Study 3 identified evidence on SOT efficacy and safety compared to best supportive care (BSC) for advanced gastroesophageal cancer, but diverse inclusion criteria and inadequate reporting led to heterogeneity in patient prognosis and control arm definition.
Conclusion
The available evidence for treating advanced EC patients lacks consistency, leading to discrepancies with recommendations by relevant CPGs. Potential bias may favor the overuse of anticancer drugs over BSC. High-quality research is urgently needed to understand SOT effectiveness versus BSC in managing advanced EC. Enhancing methodological precision, considering patient preferences, and addressing evidence gaps will contribute to informed clinical decision-making and improved patient outcomes.
https://doi.org/10.1186/s12885-021-08330-5
https://doi.org/10.1007/s12094-022-02807-w
https://onlinelibrary.wiley.com/doi/full/10.1111/jebm.12539.