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 Advanced Esophageal Cancer
  • 1.1 Esophagus
    • 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 (3): 21 day cycle
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days
    • 2.1.2 Pediatric
      • Parenteral regimen
        • Preferred regimen (1): drug name 50–75 mg/kg IV q24h for 14 (14–21) days (maximum, 2 g)
        • Alternative regimen (1): drug name 150–200 mg/kg/day IV q6–8h for 14 (14–21) days (maximum, 6 g per day)
        • Alternative regimen (2): drug name 200,000–400,000 U/kg/day IV q4h for 14 (14–21) days (maximum, 18–24 million U per day) '(Contraindications/specific instructions)'
      • Oral regimen
        • Preferred regimen (1): drug name 50 mg/kg/day PO q8h for 14 (14–21) days (maximum, 500 mg per dose)
        • Preferred regimen (2): drug name (for children aged ≥ 8 years) 4 mg/kg/day PO q12h for 14 (14–21) days (maximum, 100 mg per dose)
        • Preferred regimen (3): drug name 30 mg/kg/day PO q12h for 14 (14–21) days (maximum, 500 mg per dose)
        • Alternative regimen (1): drug name 10 mg/kg PO q6h 7–10 days (maximum, 500 mg per day)
        • Alternative regimen (2): drug name 7.5 mg/kg PO q12h for 14–21 days (maximum, 500 mg per dose)
        • Alternative regimen (3): drug name 12.5 mg/kg PO q6h for 14–21 days (maximum,500 mg per dose)
  • 2.2 'Other Organ system involved 2'

    Note (1):

    Note (2):

    Note (3):

    • 2.2.1 Adult
      • Parenteral regimen
        • Preferred regimen (1): drug name 2 g IV q24h for 14 (14–21) days
        • Alternative regimen (1): drug name 2 g IV q8h for 14 (14–21) days
        • Alternative regimen (2): drug name 18–24 MU/day IV q4h for 14 (14–21) days
      • Oral regimen
        • Preferred regimen (1): drug name 500 mg PO q8h for 14 (14–21) days
        • Preferred regimen (2): drug name 100 mg PO q12h for 14 (14–21) days
        • Preferred regimen (3): drug name 500 mg PO q12h for 14 (14–21) days
        • Alternative regimen (1): drug name 500 mg PO q6h for 7–10 days
        • Alternative regimen (2): drug name 500 mg PO q12h for 14–21 days
        • Alternative regimen (3):drug name 500 mg PO q6h for 14–21 days

• 1 Stage 2 - Name of stage
  • 1.1 Specific Organ system involved 1

    Note (1):

    Note (2):

    Note (3):

    • 1.1.1 Adult

References

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