Efficacy and Toxicity of Weekly Carboplatin and Paclitaxel as Induction or Palliative Treatment in Advanced Esophageal Cancer Patients

• Published in: Cancers Vol. 11; no. 6; p. 826
• Main Authors: de Man, Femke M, van Eerden, Ruben A G, Oomen-de Hoop, Esther, Veraart, Joris N, van Doorn, Nadia, van Doorn, Leni, van der Gaast, Ate, Mathijssen, Ron H J
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 13.06.2019; MDPI
• Subjects: Cancer therapies; Carboplatin; Chemoradiotherapy; Chemotherapy; Esophageal cancer; Esophagus; Health risk assessment; Medical prognosis; Metastases; Metastasis; Paclitaxel; Palliation; Patients; Radiation therapy; Survival; Survival analysis; Toxicity; Tumors; Womens health; United States > US; Netherlands; toxicity; induction treatment; esophageal cancer; efficacy; palliative treatment
• ISSN: 2072-6694; 2072-6694
• DOI: 10.3390/cancers11060826

Many patients have advanced esophageal cancer at diagnosis. However, the most optimal treatment has not been identified. Therefore, we evaluated a weekly regimen of carboplatin (area under the curve (AUC)) of 4 and paclitaxel at 100 mg/m as an induction or palliative treatment. All patients with advanced (gastro)esophageal cancer treated with this regimen between 2002-2018 were included. Exclusion criteria were previous radiotherapy or treatment elsewhere. Data on toxicity, response, and survival were collected. Analyses were performed in two groups: induction (iCT) or palliative chemotherapy (pCT). Median progression free survival (PFS) and overall survival (OS) were estimated with the Kaplan-Meier method. A total of 291 patients was included (iCT: 122; pCT: 169). Most patients had T3 carcinoma (iCT: 54%; pCT: 66%) and stage IV disease (iCT: 42%; pCT: 91%). A toxicity grade ≥3 occurred mainly as hematological toxicity (iCT: 71%; pCT: 73%) and gastrointestinal toxicity (iCT: 3%; pCT: 5%). Response rates were 48% (iCT) and 44% (pCT). Esophagectomy or definitive chemoradiotherapy followed in 42% of iCT, resulting in a PFS of 22.1 months (interquartile range (IQR): 12.4-114.2) and OS of 26.8 months (IQR: 15.4-91.7). For pCT, PFS was 8.2 months (IQR: 5.1-14.5) and OS 10.9 months (IQR: 6.5-18.3). This retrospective cohort study demonstrated that weekly carboplatin (AUC4) and paclitaxel (100 mg/m ) is a well-tolerated and effective induction or palliative treatment regimen for patients with locally advanced or metastatic disease. Future research should directly compare this treatment regimen with other first-line treatment options to determine its true value for clinical practice.