Have clinical research and related recommendations been consistent enough for informing the treatment of advanced esophageal cancer patients with anticancer drugs? A critical historical review

Abstract

Abstract Purpose to analyse the soundest research and recommendations that have informed the potential superiority of treatments with anticancer drugs over any type of supportive care for advanced esophageal cancer (EC). Methods We conducted a critical historical review. First, we identified randomised clinical trials (RCTs) from a previous scoping review performed by our research group ASTAC updating the search strategy. Second, we searched for the most important and recognized international clinical practice guidelines (CPGs) in advanced EC. Finally, we performed a systematic document analysis comparing whether the recommendations proposed in the CPGs were supported by the previously identified relevant evidence. Results We identified and assessed 15 randomised clinical trials and 11 clinical practice guidelines from ESMO (eight), ASCO (two) and NICE (one) published in the last 40 years. There is a clear mismatch between these guidelines’ recommendations and the available RCTs in order to inform whether anticancer drugs are more beneficial than BSC. Conclusion There is a lack of consistent evidence to treat advanced EC patients as well as a mismatch between the existing evidence and the recommendations made by relevant CPGs. As a consequence, they could have been biased when favouring the use of anticancer drugs over the supportive care.