Chemo for metastatic esophageal cancer – pro
Lay Summary: Metastatic esophageal cancer is often treated with chemotherapy. Drugs with the most supporting evidence for effectiveness are: cisplatin, 5-fluorouracil (5-FU), paclitaxel and antracyclins. How to best combine them with each other and novel agents is being studied.
More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival. A number of agents have been investigated assoletherapy for esophageal cancer, including cisplatin, irinotecan, bleomycin, mitomycin, 5-fluorouracil, paclitaxel, methotrexate, vinorelbine, mitoguazone, vindesine, doxorubicin, and etoposide. Phase II trials have demonstrated responses of 15% to 30% for these agents, with cisplatin, mitomycin, 5-fluorouracil, paclitaxel, and vindesine being the most active. The responses have beenshort livedand have not led to any meaningful prolongation of survival. Five randomized controlled trials have not shown prolonged survival but occasional palliation can be achieved. There is a need for well designed, adequately powered, phase III trials comparing chemotherapy versus best supportive care for patients with metastatic esophageal cancer. Chemotherapy agents with promising response rates and tolerable toxicity are cisplatin, 5-fluorouracil (5-FU), paclitaxel andantracyclins. Combiningtaxotereand Xeloda is not supported bysignificantliterature.
More than 50% of patients with esophageal cancer have metastatic disease at presentation. The use of chemotherapy for this patient group is increasing with the intention of local and distant tumor control, improving quality of life and prolongation of survival. Folfox results were presented at 2007 ASCO since then it became a standard regimen and listed in guidelines.
Keytruda is listed by NCCN as ”Useful in certain circumstances:, but not for PDL-1 positive cancers but for MSI-H, dMMR or TMB high. In the section “Esophageal and Esophagogastric Junciton Cnaers”, it does list PDL-1. The FDA has approved pembrolizumab (Keytruda) for use in combination with platinum and fluoropyrimidine-based chemotherapy for patients with metastatic or locally advanced esophageal or gastroesophageal carcinoma who are ineligible for surgical resection or definitive chemoradiation.
Conroy, Y. Yataghene, P. L. Etienne, P. Michel, H. Senellart, J. L. Raoul, L. Mineur, M. Rives, X. Mirabel, A. Adenis Definitive chemo-radiotherapy (CRT) with folfox 4 or 5FU-cisplatin as first line treatment for patients (pts) with inoperable esophageal cancer (IEC): Final results of a randomized phase II study. Journal of Clinical Oncology, 2007 ASCO Annual Meeting Proceedings Part I. Vol 25, No. 18S (June 20 Supplement), 2007: 4532
M. Stahl, C. Mariette, K. Haustermans, A. Cervantes, D. Arnold, Oesophageal Cancer: ESMO Clinical Practice Guidelines Ann Oncol 2013; 24 (Suppl 6): vi51-vi56.
The Cochrane Database of Systematic Reviews 2006 Issue 4 Chemotherapy for metastatic (spread to other parts of the body) cancer which originates in the esophagus.
Malthaner R, Fenlon D. Preoperative chemotherapy for resectable thoracic esophageal cancer. Cochrane Database Syst Rev 2003;(4):CD001556.
M. Koshy, N. Esiashvilli, J. C. Landry, C. R. Thomas Jr., and R. H. Matthews Multiple Management Modalities in Esophageal Cancer: Combined Modality Management Approaches Oncologist, April 1, 2004; 9(2): 147 – 159.
NCCN.ORG, Esophageal Cancer 2020
NCCN Esophageal 2022, ESOPH-F, 4