Esophageal cancer medical therapy
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
The predominant therapy for esophageal cancer is surgical. Chemotherapy is used to treat advanced esophageal cancer. Chemotherapy can be used alone as monotherapy or in combination with radiotherapy or surgery. Chemotherapy may be used as adjuvant therapy to shrink a tumor before being surgically resected or as neoadjuvant therapy after surgery to kill any cancerous cells that may have been left, and finally, in advanced tumors to shrink them or to relieve symptoms.
Medical Therapy
Medical therapy for advanced esophageal cancer includes chemotherapy such as:[1]
- Carboplatin and paclitaxel
- Combined with radiation
- Cisplatin and 5-fluorouracil (5-FU)
- Combined with radiation
- ECF: epirubicin, cisplatin, and 5-FU
- Especially for gastroesophageal junction tumors
- DCF: docetaxel, cisplatin, and 5-FU
- Cisplatin with capecitabine
- Oxaliplatin and either 5-FU or capecitabine
- Irinotecan
- For HER-2 positive esophagus cancers:
- Chemotherapy may be used along with the targeted drug trastuzumab or ramucirumab.
Esophageal cancer
- 1 Stage IV Non - Her 2 Positive Esophageal Cancer[2][3][4]
- 1.1 Advanced esophageal cancer
- 1.1.1 Adult
- Parenteral regimen
- Preferred regimen (1): 21 day cycle of docetaxel 75mg/m2 IV on day 1, cisplatin 75mg/m2 IV on day 1 and fluorouracil 750mg/m2 IV q24h from day 1 through day 5.
- Alternative regimen (1): 14 day cycle of modified docetaxel 40mg/m2 IV on day 1, leucovorin 400mg/m2 IV on day 1, fluorouracil 400mg/m2 bolus on day 1, fluorouracil 2000mg/m2 IV on day 1, cisplatin 40mg/m2 IV on day 3.
- Alternative regimen (2): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 200 mg/m2 q24h IV for up to 6 months.
- Alternative regimen (3): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 625 mg/m2 q24h PO on day 1 through day 21.
- Alternative regimen (4): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, oxaliplatin 130 mg/m2 IV on day 1, capecitabine 625 mg/m2 q24h PO on day 1 through day 21.
- Alternative regimen (5): 42 day cycle of cisplatin 30 mg/m2 IV and irinotecan 65mg/m2 IV on days 1, 8, 15, and 22.
- Alternative regimen (6): 21 day cycle of oxaliplatin 130mg/m2 IV on day 1, capecitabine 1000mg/m2 q24h PO on day 1 through day 14.
- Parenteral regimen
- Note (1): Treatment is continued until disease progression, unacceptable toxicity or patient withdrawal.
- 1.1.1 Adult
- 1.1 Advanced esophageal cancer
- 2 Stage IV Her 2 Positive Esophageal Cancer
- 2.1 Advanced esophageal cancer
- 2.1.1 Adult
- Parenteral regimen
- Preferred regimen (1): 21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, capecitabine 1000mg/m2 q24h PO on day 1 through day 14, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2.
- Alternative regimen (1):21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, fluorouracil 800mg/m2 q24h IV on day 1 through day 5, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2.
- Parenteral regimen
- 2.1.1 Adult
- 2.1 Advanced esophageal cancer
- 3 Weekly Carboplatin and Paclitaxel with concurrent Radiotherapy
- 3.1 Advanced esophageal cancer and esophagogastric junction cancer
- 3.1.1 Adult
- Parenteral regimen
- Preferred regimen (1): Paclitaxel 50mg/m2 IV and carboplatin AUC 2mg/ml x min IV on day 1, 8, 15, 22 and 29.
- Note (1): Given weekly for 5 weeks with concurrent radiotherapy followed by surgery.
- Alternative regimen (1): Cisplatin 100 mg/m2 IV on day 1 through 29, 5-FU 1000 mg/m2 q24h IV on day 1 through 4 and days 29 through 32 and radiotherapy 50.4 Gy.
- Note (2): 1.8 Gy for 5 days a week (final 5.4 Gy is given as a boost) on day 1 through 5, day 8 through 12, day 15 through 19, day 22 through 29. day 22 through 26, day 29 through 33, day 36 through 38.
- Note (3): Two courses of cisplatin and 5-FU are given on days 1 and 29 of a 5.5 week course of radiotherapy.
- Note (4): Trimodality therapy with cisplatin and 5-FU with concurrent radiotherapy followed by surgery.
- Parenteral regimen
- 3.1.1 Adult
- 3.1 Advanced esophageal cancer and esophagogastric junction cancer
References
- ↑ O'Reilly S, Forastiere AA (1995). "Is surgery necessary with multimodality treatment of oesophageal cancer". Ann. Oncol. 6 (6): 519–21. PMID 8573528.
- ↑ Kelsen DP, Ginsberg R, Pajak TF, Sheahan DG, Gunderson L, Mortimer J, Estes N, Haller DG, Ajani J, Kocha W, Minsky BD, Roth JA (1998). "Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer". N. Engl. J. Med. 339 (27): 1979–84. doi:10.1056/NEJM199812313392704. PMID 9869669.
- ↑ Bosset JF, Gignoux M, Triboulet JP, Tiret E, Mantion G, Elias D, Lozach P, Ollier JC, Pavy JJ, Mercier M, Sahmoud T (1997). "Chemoradiotherapy followed by surgery compared with surgery alone in squamous-cell cancer of the esophagus". N. Engl. J. Med. 337 (3): 161–7. doi:10.1056/NEJM199707173370304. PMID 9219702.
- ↑ Hulscher JB, van Sandick JW, de Boer AG, Wijnhoven BP, Tijssen JG, Fockens P, Stalmeier PF, ten Kate FJ, van Dekken H, Obertop H, Tilanus HW, van Lanschot JJ (2002). "Extended transthoracic resection compared with limited transhiatal resection for adenocarcinoma of the esophagus". N. Engl. J. Med. 347 (21): 1662–9. doi:10.1056/NEJMoa022343. PMID 12444180.