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Long-term outcome of a phase II study of docetaxel-based multimodality chemoradiotherapy for locally advanced carcinoma of the esophagus or gastroesophageal junction

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Abstract

We performed a phase II trial to evaluate a docetaxel-based regimen in locoregionally advanced esophageal cancer. Untreated stage II–IVa esophageal cancer patients with performance status 0–2 were included. Tumor resectability was determined prior to initiation of study. Induction docetaxel (75 mg/m2) and cisplatin (75 mg/m2) day 1 with prophylactic filgrastim was delivered every 21 days for 3 cycles. Subsequent concomitant chemoradiotherapy (CRT) utilized weekly docetaxel (20 mg/m2) and concurrent radiotherapy (2 Gy/day) in resectable/resected patients (50 Gy) and in unresectable patients (66 Gy). A total of 78 patients (15 squamous cell carcinoma, 60 adenocarcinoma, 3 mixed/undifferentiated; 68 men, 10 women; median age 61 years) were accrued. The regimen was administered to 59 (76%) potentially resectable patients and 13 (17%) unresectable patients; 6 patients (8%) received the regimen post-operatively. Response rate in 66 evaluable patients following induction chemotherapy was 30%. Sixty-nine patients underwent CRT. Ten patients had disease progression during CRT. Forty-five out of 59 potentially resectable patients underwent esophagectomy after CRT, and 42 patients had complete tumor resection with negative margins. Eighteen out of 59 patients who were potentially resectable patients had pathologic complete response (pCR—31%). Grade 3/4 toxicity during induction chemotherapy included leucopenia, neutropenia, vomiting, and neuropathy. Esophagitis was the predominant toxicity during CRT. Median overall survival was 11.4 months for unresectable patients, 14.3 months for resectable patients and 10.4 months for patients who received the regimen post-operatively (log-rank P = 0.2492). Docetaxel-based CRT regimen is active and tolerable in esophageal cancer. The observed pCR in the potentially resectable group indicates good local control.

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Acknowledgments

This study was supported by Sanofi-Aventis, University of Chicago Cancer Center (CM107102-02), and Valda and Robert Svendsen Foundation.

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Authors and Affiliations

  1. Section of Hematology-Oncology, University of Chicago Medical Center, MC 2115, 5841, S. Maryland Avenue, Chicago, IL, 60637, USA

    Nicholas W. Choong, Ann M. Mauer, Philip C. Hoffman, Livia Szeto & Everett E. Vokes

  2. University of Chicago Cancer Research Center, 5841, S. Maryland Avenue, Chicago, IL, 60637, USA

    Mark K. Ferguson, Philip C. Hoffman, Livia Szeto & Everett E. Vokes

  3. Department of Radiation Biology and Cellular Oncology, University of Chicago Medical Center, MC 9006, 5841, S. Maryland Avenue, Chicago, IL, 60637, USA

    Daniel C. Haraf

  4. Department of Surgery, Section of Cardiac and Thoracic Surgery, University of Chicago Medical Center, MC 5035, 5841, S. Maryland Avenue, Chicago, IL, 60637, USA

    Mark K. Ferguson

  5. Oregon Health Sciences University, 3181 S.W. Sam Jackson Park Road, Portland, OR, 97239, USA

    Alan B. Sandler

  6. Division of Thoracic Surgery, Indiana University School of Medicine, EH-215, 545 Barnhill Dr., Indianapolis, IN, 46202, USA

    Kenneth A. Kesler

  7. Illinois Cancer Care, 8940 N. Wood Sage Road, Peoria, IL, 61615, USA

    Paul A. S. Fishkin

  8. Michiana Hematology Oncology, Pc 100 Navarre Pl, Ste 5550, South Bend, IN, 46601, USA

    Rafat H. Ansari

  9. Cancer Care Specialists of Central Illinois, S.C 2880 N. Monroe, Decatur, IL, 62526, USA

    James Wade III

  10. Lakefront Oncology Association, Strauss Cancer Centre, 4700 North Marine Drive, Suite 315, Chicago, IL, 60640, USA

    Stuart A. Krauss

  11. Guthrie Clinic Sayre, 1 Guthrie Square, Sayre, PA, 18840, USA

    David F. Sciortino

  12. Department of Surgery, Section of General Surgery and Surgical Oncology, University of Chicago Medical Center, MC 5094, 5841, S. Maryland Avenue, Chicago, IL, 60637, USA

    Mitchell C. Posner

  13. Department of Health Studies, University of Chicago, MC 2007, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA

    Masha Kocherginsky

  14. Division of Neoplastic Diseases, Medical College of Wisconsin, 9200 W. Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Nicholas W. Choong

  15. Creticos Cancer Center, Advocate Illinois Masonic Medical Center, 901 W. Wellington Avenue, Chicago, IL, 60657, USA

    Ann M. Mauer

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  1. Nicholas W. Choong
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Correspondence to Nicholas W. Choong.

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Choong, N.W., Mauer, A.M., Haraf, D.C. et al. Long-term outcome of a phase II study of docetaxel-based multimodality chemoradiotherapy for locally advanced carcinoma of the esophagus or gastroesophageal junction. Med Oncol 28 (Suppl 1), 152–161 (2011). https://doi.org/10.1007/s12032-010-9658-1

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