There had recently been much evolution in the treatment of esophageal cancer. Among changes has been greater recognition of Xeloda and of Oxapliplatin as effective drugs. Ths isbased on thhREAL trial. The REAL trial enrolled 1,002 patients with locally advanced (inoperable) or metastatic cancer of the esophagus, esophagogastric junction, or stomach.
Patients were assigned to one of four treatment groups:
ECF (Ellence® (epirubicin), cisplatin, and 5-FU)
ECX (Ellence, cisplatin, and Xeloda)
EOF (Ellence, Eloxatin, and 5-FU)
EOX (Ellence, Eloxatin, and Xeloda)
One-year survival was 37.7% for ECF, 40.8% for ECX, 40.4% for EOF, and 46.8% for EOX.
Progression-free survival and response rates did not differ significantly across treatment groups. Overall survival was longer with EOX than with ECF.
In response to favorable Phase III trials (ML 17032 and REAL 2), the NCCN recently added oral fluoropyrimidine, Capecitabine (Xeloda®, Roche) as an option for treatment of esophageal and gastric cancer. The REAL 2 study, the largest ever phase III study in advanced esophageal and gastric cancer, found that Capecitabine may replace 5-FU and Oxaliplatin may replace Cisplatin in triplet regimens used for the treatment of advanced esophageal and gastric cancer. Thus, Xelox should be cosndiered appropriate for esophageal cancer.
Cunningham D, Starling N, Rao S et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. New England Journal of Medicine. 2008;358:36-46.
R. Quek, W. T. Lim, K. F. Foo, W. H. Koo, H. C. Toh Capcitabine and oxaliplatin (XELOX) in the treatment of advanced gastric cancer.Journal of Clinical Oncology, 2006 ASCO Annual Meeting Proceedings Part I. Vol 24, No. 18S (June 20 Supplement), 2006: 14089
nccn.org, esophageal 2012