EPIRUBICIN, CISPLATIN, AND PROTRACTED VENOUS INFUSION OF 5-FLUOROURACIL FOR ESOPHAGOGASTRIC ADENOCARCINOMA - RESPONSE, TOXICITY, QUALITY-OF-LIFE, AND SURVIVAL

BACKGROUND. The results of chemotherapy for patients with esophagogast ric carcinoma have generally been modest but regimens developed more r ecently have produced higher response rates, and rekindled interest in neoadjuvant chemotherapy. One such regimen is epirubicin, cisplatin, and 5-fluorouracil (ECF). This study evaluates its efficacy, toxicity, impact on quality of life (QL), and impact on survival in a large con secutive series of patients with metastatic and locally advanced disea se (LAD). METHODS. Patients with histologically confirmed esophagogast ric carcinoma were treated with ECF (epirubicin 50 mg/m(2) and cisplat in 60 mg/m(2) every 3 weeks with continuous infusion of 5-fluorouracil (5-FU) 200 mg/m(2)/d). Responses were evaluated with computed tomogra phy (CT) scan and endoscopy, QL was assessed using the European Organi zation for Research and Treatment of Cancer QLQ-C30 questionnaire. RES ULTS. A total of 235 patients were treated, 173 with metastatic diseas e and 62 with LAD. The mean number of cycles delivered was 6 (range: 1 -11) and patients were followed-up for a median of 8 months. Response was observed in 135 of 220 (61%) evaluable patients, with a complete r esponse (CR), 11% of the patients and a partial response in 50% of the patients. Patients with moderately differentiated adenocarcinomas and LAD responded most favorably. Symptomatic improvement was achieved in the majority of cases (63-78% depending on the symptom). Toxicity was generally only mild to moderate, with severe non hematologic toxicity in less than 12% of the patients and only 6 (2.5%) treatment related deaths. QL assessment showed no significant negative impact on emotion al functioning and good symptomatic control. Surgery following respons e to ECF was performed in 29 of the LAD patients, and in 19 cases (66% ) a potentially curative resection was possible, with histologic CR in 32% of the patients. CONCLUSIONS. ECF is a highly active regimen with acceptable toxicity in patients with esophagogastric adenocarcinoma. In a proportion of patients with LAD, chemotherapy enabled potentially curative surgery to be performed. The results justify further investi gation of this regimen in a neoadjuvant setting. (C) 1996 American Can cer Society.