Neoadjuvant therapy with weekly docetaxel and cisplatin, 5‐fluorouracil continuous infusion, and concurrent radiotherapy in patients with locally advanced esophageal cancer produced a high percentage of long‐lasting pathological complete response

Abstract

BACKGROUND: This phase 2 study was aimed at defining the pathological response rate of a neoadjuvant schedule including weekly docetaxel and cisplatin, continuous infusion (c.i.) of 5-fluorouracil (5-FU) and concomitant radiotherapy (RT) in untreated stage II-III adenocarcinoma and squamous cell carcinoma of mid-distal thoracic esophagus. METHODS: The schedule consisted of a first phase of chemotherapy alone and of a second phase of concurrent chemoradiation. Doses were as follows: docetaxel 35 mg/m 2 and cisplatin 25 mg/m 2 on days 1, 8,15,29,36,43, 50, and 57 plus 5-FU c.i. (180 mg/m 2 on days 1-21 and 150 mg/m 2 on days 29-63); RT (50 Gy) started at day 29. Surgery was planned 6 to 8 weeks after the completion of chemoradiation. RESULTS: A total of 74 patients were enrolled; pathological complete remission (pCR) was found in 47% (35 of 74) and near pCR (microfoci of tumor cells on the primary tumor without lymph nodal metastases) (pnCR) in 15% of the patients (11 of 74). Grade 3-4 neutropenia, nonhematological toxicity, and toxic deaths occurred in 13.5%, 32.4%, and 4% of the patients, respectively. Median follow-up was 55 months (range, 3-108 months). Median survival of all 74 patients was 55 months, whereas it was not reached in the pCR subset. The 3-and 5-year survival rates were, respectively, 83% and 77% for pCR, 73% and 44% for pnCR, and 21% and 14% for Residual Tumor subsets (P <.001). CON-CLUSIONS: This study shows that 1) this intensive weekly schedule produced a high pathological response rate, 2) responders had

Neoadjuvant chemoradiotherapy with cisplatin plus vinorelbine versus cisplatin plus fluorouracil for esophageal squamous cell carcinoma: A matched case–control study

“…However, the pCR rate after neoadjuvant CRT for the PF group (28.1%) was consistent with that of previous reports, which mainly comprised esophageal SCC (9.8-49%) [2,[4][5][6]. The 3-year OS rate for patients who received PF in our series (31.3%) was also within the wide range reported in the literature (27-61% at 3 years) [2][3][4][5][6][15][16][17][18][19][20]. Compared with PF, patients who received NP had a significantly higher pCR rate (47.4%) and superior survival.…”

“…Nevertheless, several retrospective studies have revealed that paclitaxel-based regimens did not result in superior pCR and survival compared to traditional fluorouracil-based chemotherapy [15][16][17]. The efficacy of three-drug, paclitaxel-containing regimens has been investigated as well [18][19][20]. Kelsey et al reported clinical results using PF versus paclitaxel/carboplatin/fluorouracil [19].…”

Neoadjuvant chemotherapy in borderline resectable pancreatic cancer: A case report

“…In malignancies such as rectal, esophageal and breast cancer, pCR has been associated with improved disease-free survival and OS (73)(74)(75)(76)(77)(78)(79)(80)(81)(82)(83). In PAC, a number of studies reported pathologic outcomes following neoadjuvant chemotherapy with or without fractionated radiotherapy or stereotactic body radiotherapy, and the pCR rate ranges between 2.4 and 32.0% (41,(84)(85)(86)(87)(88)(89)(90)(91)(92)(93)(94).…”

Two Cases of Pathological Complete Response to Neoadjuvant Chemoradiation Therapy in Pancreatic Cancer

“…[10][11][12][13]15,20,21 In general, the margin-free resection rate or 6-month progression-free survival is used as an effective surrogate marker of NACRT efficacy in PDA. The pathological response rate is also gaining recognition as an important surrogate.…”