Results of a planned interim toxicity analysis with trimodality therapy, including carboplatin AUC = 4, paclitaxel, 5-fluorouracil, amifostine, and radiation for locally advanced esophageal cancer: preliminary analyses and treatment recommendations from the North Central Cancer Treatment Group

International Seminars in Surgical Oncology - Tập 1 - Trang 1-5 - 2004
Aminah Jatoi1, James Martenson1, Michelle R Mahoney1, Bradley S Lair2, Jeffrey S Brindle3, Frank Nichols1, Normand Caron4, Kendrith Rowland5, Loren Tschetter, Steven Alberts1
1Mayo Clinic, Rochester, USA
2Iowa Oncology Research Association Cancer Cooperative Oncology Program, Des Moines, USA
3Altru Health Systems, Grand Forks, USA
4Toledo Community Hospital Cancer Cooperative Oncology Program, Toledo, USA
5Sioux Community Cancer Consortium, Sioux Falls, USA

Tóm tắt

An aggressive trimodality approach from the Minnie Pearl Cancer Research Network [carboplatin AUC = 6, days 1 and 22; 5-fluorouracil 225 mg/m2 continuous infusion, days 1–42, paclitaxel 200 mg/m2, days 1 and 22; 45 Gy] has resulted in remarkable pathologic response rates but notable toxicity. This trial was designed to mitigate this toxicity by starting with a lower carboplatin dose, AUC = 4, and by adding subcutaneous amifostine. This phase II trial included patients with locally advanced, potentially resectable esophageal cancer. All were to receive the above regimen with modifications of carboplatin AUC = 4 and amifostine 500 mg subcutaneously before radiation. All were then to undergo an esophagectomy. A planned interim toxicity analysis after the first 10 patients was to determine whether the carboplatin dose should escalate to AUC = 6. Ten patients were enrolled, and all required dose reductions/omissions during neoadjuvant therapy. One patient died from paclitaxel anaphylaxis. Six patients manifested a complete pathologic response. With this regimen, carboplatin AUC = 4 for patients with locally advanced esophageal cancer is appropriate.

Từ khóa


Tài liệu tham khảo

Walsh TN, Noonan N, Hollywood D, et al: A comparison of multimodality therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996, 335: 462-7. 10.1056/NEJM199608153350702.

Urba S: Combined modality therapy of esophageal cancer – standard of care?. Surg Oncol Clin N Am. 2002, 11: 377-86.

Meluch AA, Hainsworth JD, Gray JR, et al: Preoperative combined modality therapy with paclitaxel, carboplatin, prolonged infusion 5-fluorouracil, and radiation therapy in localized esophageal cancer: preliminary results of a Minnie Pearl Cancer Research Network phase II trial. Cancer J Sci Am. 1999, 5: 84-91.

Kleinberg L, Knisely JPS, Heitmiller R, et al: Mature survival results with preoperativ cisplain, protracted infusional 5-fluorouracil, and 44 Gy radiotherapy for esophageal cancer. Int J Radiation Oncol Biol Phys. 2003, 56: 328-334. 10.1016/S0360-3016(02)04598-4.

Meluch AA, Greco FA, Burris JR, et al: Preoperative paclitaxel, carboplatin, 5-FU and radiation therapy for localized esophageal cancer: final results of a Minnie Pearl Cancer Research Network phase II trial. Proceedings of the American Society of Clinical Oncology. 2001, 636A-

Zemanova M, Pazdro A, Novak F, et al: Neoadjuvant chemotherapy with paclitaxel, carboplatin, 5-fluorouracil with consecutive surgery in esophageal cancer. Annals of Oncology. 2002, 13 (Suppl 5): 188-

Koukourakis MI, Kyrias G, Kakolyris S, et al: Subcutaneous administration of amifostine during fractionated radiotherapy: a randomized phase II study. J Clin Oncol. 2000, 18: 2226-2233.

Anne PR, Curran WJ: A phase II trial of subcutaneous amifostine and radiation therapy in patients with head and neck cancer. Semin Radiat Oncol. 2002, 12 (Suppl 1): 18-19.

Therasse P, Arbuck SG, Eisenhauer EA, et al: New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst. 2000, 92: 205-16. 10.1093/jnci/92.3.205.

Thông tin
Thông tin xuất bản

International Seminars in Surgical Oncology

Tập 1

1-5

Thông tin tác giả