ACTIVITY OF TAXOL IN PATIENTS WITH SQUAMOUS-CELL CARCINOMA AND ADENOCARCINOMA OF THE ESOPHAGUS

Background: Carcinomas of the esophagus and gastroesophageal junction are uncommon and account for approximately 1% of all malignancies in t he United States. Advanced squamous cell carcinoma or adenocarcinoma o f these sites remains incurable. The median survival of patients is be tween 4 and 8 months, and their prognosis has not changed in the past several decades. Undoubtedly, there is an urgent need to develop new e ffective drugs for patients with carcinoma of the esophagus or the gas troesophageal junction. Purpose: Our purpose was to evaluate the respo nse rate, duration of response, and toxic effects in previously untrea ted patients with unresectable local-regional or metastatic carcinoma of the esophagus who were enrolled in a phase II study of paclitaxel ( Taxol). Methods: Fifty-two patients with either metastatic or local-re gional unresectable carcinoma of the esophagus were eligible for this study. All patients were premedicated with dexamethasone, cimetidine, and diphenhydramine hydrochloride to prevent allergic reaction. The st arting dose of paclitaxel was 250 mg/m(2) repeated every 21 days. Pati ents received 5 mu g/kg granulocyte-colony stimulating factor (G-CSF) subcutaneously daily 24 hours after the completion of paclitaxel to re duce the duration and severity of granulocytopenia. Results: Of the 52 patients who were initially enrolled, 50 (44 men and six women) were evaluated for toxic effects and response. Thirty-two had adenocarcinom a, and 18 had squamous cell carcinoma. The median age was 58 years (ra nge, 36-77 years). The median Zubrod performance status was 1 (range, 0-1). The median number of courses was four, and the total number of c ourses administered was 227. The median dose of paclitaxel was 250 mg/ m(2) (range, 150-280 mg/m(2)). Paclitaxel dosage was reduced in 52 (23 %) of 227 courses and increased in 15 (7%) of 227 courses. Sixteen (32 %) patients achieved either a complete or partial response, and 11 (22 %) achieved a minor response. Among 32 patients with adenocarcinoma, 1 1 (34%; 95% confidence interval [CI] = 18%-50%) had either a complete or partial response and six had a minor response. Five (28%; 95% CI = 7%-49%) of 18 patients with squamous cell carcinoma had a partial resp onse, and five (28%) had a minor response. The median duration of part ial response was 17 weeks (range, 7 to greater than or equal to 58 wee ks). At a median follow-up of 9 months, 32 patients remain alive, with an actuarial median survival duration of 13.2 months (range, 2 to gre ater than or equal to 117.5 months). Paclitaxel followed by G-CSF was very well tolerated. Conclusions: These data indicate that paclitaxel is an active agent against adenocarcinoma and squamous cell carcinoma of the esophagus.