Esophageal cancer medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]

Overview

Chemotherapy is used to treat advanced esophageal cancer. Chemotherapy can be used alone as monotherapy or in combination with radiotherapy or surgery. Chemotherapy may be used as a neoadjuvant therapy after surgery to kill any cancerous cells that may have been left, or as an adjuvant therapy to shrink a tumor before being surgically resected, and finally, in advanced tumors to shrink them or to relieve symptoms.

Medical Therapy

• Some common drugs and drug combinations used to treat advanced esophageal cancer include:
  • Carboplatin and paclitaxel
    • Combined with radiation
  • Cisplatin and 5-fluorouracil (5-FU)
    • Combined with radiation
  • ECF: epirubicin, cisplatin, and 5-FU
    • Especially for gastroesophageal junction tumors
  • DCF: docetaxel, cisplatin, and 5-FU
  • Cisplatin with capecitabine
  • Oxaliplatin and either 5-FU or capecitabine
  • Irinotecan
  • For some esophagus cancers that are HER-2 positive, chemo may be used along with the targeted drug trastuzumab or ramucirumab.

Esophageal cancer

• 1 Stage IV Non - Her 2 positive Esophageal Cancer
  • 1.1 Advanced esophageal cancer
    • 1.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): 21 day cycle of docetaxel 75mg/m2 IV on day 1, cisplatin 75mg/m2 IV on day 1 and fluorouracil 750mg/m2 IV q24h from day 1 through day 5
        • Alternative regimen (1): 14 day cycle of modified docetaxel 40mg/m2 IV on day 1, leucovorin 400mg/m2 IV on day 1, fluorouracil 400mg/m2 bolus on day 1, fluorouracil 2000mg/m2 IV on day 1, cisplatin 40mg/m2 IV on day 3
        • Alternative regimen (2): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 200 mg/m2 q24h IV for up to 6 months
        • Alternative regimen (3): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, cisplatin 60 mg/m2 IV on day 1, fluorouracil 625 mg/m2 q24h PO on day 1 through day 21
        • Alternative regimen (4): 21 day cycle of epirubicin 50 mg/m2 IV on day 1, oxaliplatin 130 mg/m2 IV on day 1, cepacitabine 625 mg/m2 q24h PO on day 1 through day 21
        • Alternative regimen (5): 42 day cycle of cisplatin 30 mg/m2 IV and irinotecan 65mg/m2 IV on days 1, 8, 15, and 22
        • Alternative regimen (6): 21 day cycle of oxaliplatin 130mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14

    Note (1): Treatment is continued until disease progression, unacceptable toxicity or patient withdrawal

• 2 Stage IV Her 2 positive Esophageal Cancer
  • 2.1 Advanced esophageal cancer
    • 2.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): 21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, cepacitabine 1000mg/m2 q24h PO on day 1 through day 14, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2
        • Alternative regimen (1):21 day cycle for 6 cycles; cisplatin 80 mg/m2 IV on day 1, fluorouracil 800mg/m2 q24h IV on day 1 through day 5, trastuzumab 8mg/kg IV loading dose on day 1 for cycle 1 only, followed by 6mg/kg IV on day 1 of every subsequent cycle starting with cycle 2
• 3 Weekly Carboplatin and Paclitaxel with concurrent Radiotherapy
  • 3.1 Advanced esophageal cancer and esophagogastric junction cancer
    • 3.1.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): Paclitaxel 50mg/m2 IV and carboplatin AUC 2mg/ml x min IV on day 1, 8, 15, 22 and 29

        Note (1): Given weekly for 5 weeks with concurrent radiotherapy followed by surgery

        • Alternative regimen (1): Cisplatin 100 mg/m2 IV on day 1 through 29, fluorouracil 1000 mg/m2 q24h IV on day 1 through 4 and days 29 through 32 and radiotherapy 50.4 Gy

        Note (2): 1.8 Gy for 5 days a week (final 5.4 Gy is given as a boost) on day 1 through 5, day 8 through 12, day 15 through 19, day 22 through 29. day 22 through 26, day 29 through 33, day 36 through 38

        Note (3): Two courses of cisplatin and fluorouracil are given on days 1 and 29 of a 5.5 week course of radiotherapy

        Note (4): Trimodality therapy with cisplatin and fluorouracil with concurrent radiotherapy followed by surgery

References

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