544 ECF is a highly active regimen with low toxicity suitable for neoadjuvant treatment of oesophagogastric cancer

Abstract

Initial trials with ECF demonstrated a 71% response in oesophagogastric cancer with modest toxicity, renewing interest in neoadjuvant therapy. We now report our experience of 235 consecutive patients treated between 1989 and 1994. All diagnoses were histologically proven. The regimen comprises epirubicin 50 mg/m 2 and cisplatin 60 mg/m 2 3 weekly × 6–8 with protracted venous infusion 5-FU 200 mg/m 2 /d throughout. Responses were evaluated with CT scan and gastroscopy. 173 patients had metastatic disease and 62 had locally advanced disease (LAD). Measurable response occurred in 135/220 (61%, 95% CI 55–68%) with CR in 11% and PR in 50%. Symptomatic response occurred in 50–85%. Quality of life was improved or maintained in most patients. Toxicity was modest; 22% grade 3/4 leucopenia and 14% grade 3/4 non-haematological toxicity. There were 6 treatment related deaths, all during the first 3 years. 29 patients with LAD who responded proceeded to surgery. 19 (66%) had a potentially curative resection; histological CR was demonstrated in 6 (32%). Overall median survival was 256 days. Patients with LAD and ECOG performance status 0–2 had a median survival of 404 days with a 1 year failure free rate of 40%. We conclude ECF is a highly active regimen with acceptable toxicity that can render locally advanced tumours operable. This potential is being evaluated in the MRC ″MAGIC″ trial comparing ECF before surgery with surgery alone.