Jj. Lokich et al., Combined paclitaxel, cisplatin, and etoposide for patients with previouslyuntreated esophageal and gastroesophageal carcinomas, CANCER, 85(11), 1999, pp. 2347-2351
BACKGROUND, Paclitaxel (T), etoposide (E), and cisplatin (P) are each activ
e in gastric carcinoma, either as single agents or as part of a multidrug r
egimen. To the authors' knowledge, the combination of these three agents in
the treatment of patients with esophageal or gastroesophageal carcinoma ha
s not been previously studied.
METHODS. Previously untreated patients with locally advanced carcinoma of t
he stomach, esophagus, or gastroesophageal (GE) junction received at least
2 cycles of TPE administered twice weekly for 3 weeks, with the cycle repea
ted every 28 days. Drug doses, administered over 3 hours on either Monday a
nd Thursday or Tuesday and Friday, consisted of T 50 mg/m(2)/dose, P 15 mg/
m(2)/dose, and E 40 mg/m(2)/dose. For patients with local disease only, sub
sequent therapy consisted of radiation with or without surgical resection.
RESULTS. Twenty-five patients with gastric (10) or gastroesophageal or GE j
unction (15) carcinoma were treated. Eighteen had locally advanced disease
and 7 had liver metastases at presentation. Hematologic toxicity, namely, G
rade 3 anemia and neutropenia, was experienced by all patients. The median
number of treatment cycles was 4 (range, 2-6). Three patients were not eval
uable for response. AU 22 evaluable patients responded; 3 were complete res
ponders and 19 were partial responders. Eleven patients received radiation
therapy with (6) or without (5) concomitant 5-fluorouracil, and 8 patients
subsequently underwent surgical resection. Three of 8 patients had no tumor
at surgery, 4 had minimal microscopic tumor at the primary site, and 3 had
microscopic lymph node involvement. Twenty-three patients are alive, of wh
om 14 are without evidence of disease. Two patients with metastatic disease
at presentation died at 9 and 29 months, respectively. The median survival
was 12.5 months (range, 6 to 30+ months).
CONCLUSIONS. Multifractionated TPE chemotherapy is a highly active regimen
in gastric and gastroesophageal carcinoma. It could be evaluated in Phase I
II trials against other active regimens for the treatment of patients with
this disease. The introduction of 5-fluorouracil could also be an interesti
ng direction to explore because of its primary role in the treatment of pat
ients with gastric and esophageal carcinoma. Cancer 1999;85:2347-51. (C) 19
99 American Cancer Society.