Oral Paclitaxel Improves Survival in Second-Line Advanced Gastric Cancer: ESMO Open | August 2026

Introduction:

Paclitaxel remains an important second-line treatment for advanced gastric cancer, but intravenous administration requires infusion-centre visits and carries risks of neuropathy and hypersensitivity reactions. This phase III trial evaluated whether an oral paclitaxel formulation could provide comparable—or superior—outcomes after progression on fluoropyrimidine-based therapy.

Why was this study needed?

IV paclitaxel creates substantial treatment and infusion burden.

An effective oral taxane could improve convenience and avoid routine hypersensitivity premedication.

Oral administration may produce a different toxicity profile from conventional IV paclitaxel.

Phase III evidence was required to establish efficacy.

Results:

Among 536 patients, oral paclitaxel significantly improved median overall survival: 9.13 vs 6.54 months (HR 0.77).

PFS was similar (3.02 vs 2.89 months) and met the predefined noninferiority criterion.

Objective response was numerically higher with oral therapy (13.6% vs 9.8%).

Oral paclitaxel caused less neuropathy, alopecia, and hypersensitivity, but more diarrhea and treatment interruptions.

Clinical Impact:

An oral taxane producing an overall-survival advantage while eliminating IV administration is clinically attractive. However, an important limitation is the comparator: q3-weekly IV paclitaxel does not represent the contemporary ramucirumab plus weekly paclitaxel standard used in many regions. In addition, the trial population was entirely Chinese, limiting immediate global generalizability.

Bottom Line:

Oral paclitaxel improved overall survival and reduced several classic taxane toxicities compared with q3-weekly IV paclitaxel in second-line advanced gastric cancer. It is a promising and convenient therapeutic option—but comparison with contemporary standards and broader international validation are needed before it becomes globally practice-changing.