Combined paclitaxel, cisplatin, and etoposide for patients with previouslyuntreated esophageal and gastroesophageal carcinomas

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.