Chemoradiotherapy Using Carboplatin plus Paclitaxel versus Cisplatin plus Fluorouracil for Esophageal or Gastroesophageal Junction Cancer

Abstract

<b><i>Background:</i></b> Trimodality therapy (TMT) with neoadjuvant chemoradiotherapy (nCRT) using concurrent carboplatin plus paclitaxel (CP) followed by surgery is the standard of care for locoregional esophageal or gastroesophageal junction (GEJ) cancers. Alternatively, nCRT with cisplatin plus fluorouracil (CF) can be used. Definitive chemoradiotherapy (dCRT) with CP or CF can be used if surgery is not planned. In the absence of comparative trials, we aimed to evaluate outcomes of CP and CF in the settings of TMT and dCRT. <b><i>Methods:</i></b> A single-site, retrospective cohort study was conducted at the Princess Margaret Cancer Centre to identify all patients who received CRT for locoregional esophageal or GEJ cancer. Overall survival (OS) and disease-free survival (DFS) were assessed using the Kaplan-Meier method and multivariable Cox regression model. The inverse probability treatment weighting (IPTW) method was used for sensitivity analysis. <b><i>Results:</i></b> Between 2011 and 2015, 93 patients with esophageal (49%) and GEJ (51%) cancers underwent nCRT (<i>n</i> = 67; 72%) or dCRT (<i>n</i> = 26; 28%). Median age was 62.3 years and 74% were male. Median follow-up was 23.9 months. Comparing CP to CF in the setting of TMT, the OS and DFS rates were similar. In the setting of dCRT, CP was associated with significantly inferior 3-year OS (36 vs. 63%; <i>p</i> = 0.001; HR 3.1; 95% CI: 1.2–7.7) and DFS (0 vs. 41%; <i>p</i> = 0.004; HR 3.6; 95% CI: 1.4–8.9) on multivariable and IPTW sensitivity analyses. <b><i>Conclusions:</i></b> TMT with CF and CP produced comparable outcomes. However, for dCRT, CF may be a superior regimen.

Preoperative Radiochemotherapy in Esophageal Squamous Cell Cancer with 5-Fluorouracil/Cisplatin or Carboplatin/Paclitaxel: Treatment Practice over a 20-Year Period and Implications for the Individual Treatment Modalities

“…Currently, the 'National Comprehensive Cancer Network' guidelines give a category 1 recommendation for both regimens [19]. There have only been few retrospective studies, which could not consistently demonstrate a superiority for either regimen [8,[20][21][22]. Thus, this issue certainly remains of scientific interest [8].…”

Comparison of Efficacy and Safety of Taxanes Plus Platinum and Fluorouracil Plus Platinum in the First-Line Treatment of Esophageal Cancer: A Systematic Review and Meta-Analysis

“…Through preliminary inspection, a total of 1300 relevant studies were obtained, including 1298 which met the inclusion criteria and 2 similar reading articles. After further screening, 34 articles were obtained for further evaluation [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 ]. Among these studies, the chemotherapy regimen of one and the study objects of two did not meet the inclusion criteria.…”

“…Among these studies, the chemotherapy regimen of one and the study objects of two did not meet the inclusion criteria. Finally, a total of 31 articles involving 3432 participants were included [ 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 ]. The detailed retrieval process of this review is shown in Figure 1 .…”

Trimodality treatment in gastric and gastroesophageal junction cancers: Current approach and future perspectives

“…A retrospective study by Jiang DM et al [ 73 ] compared carboplatin plus paclitaxel with cisplatin plus fluorouracil as chemotherapy regimens in patients with resectable tumors of the esophagus and GEJ that received neoadjuvant chemoradiotherapy. The study also included patients who did not proceed to surgical resection and received definitive chemoradiation.…”

“…In patients who received surgery, no difference was observed between the two treatment groups. However, in the definitive chemoradiation subgroup, carboplatin-paclitaxel was associated with significantly worse 3-year OS (36% vs 63% P = 0.001 HR 3.1, 95%CI: 1.2-7.7) and DFS (0% vs 41%; P = 0.004; HR 3.6, 95%CI: 1.4-8.9)[ 73 ].…”