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

• Main Authors: Femke M. de Man, Ruben A.G. van Eerden, Esther Oomen-de Hoop, Joris N. Veraart, Nadia van Doorn, Leni van Doorn, Ate van der Gaast, Ron H.J. Mathijssen
• Format: Article
• Language: English
• Published: MDPI AG 2019-06-01
• Series: Cancers
• Subjects: esophageal cancer; induction treatment; palliative treatment; efficacy; toxicity
• Online Access: https://www.mdpi.com/2072-6694/11/6/826

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/m² 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/m²) 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.