AOS28 High pathological response rate with docetaxel plus cisplatin plus fluorouracil induction regimen in oesophageal cancer: Initial experience

Abstract

Background Induction chemotherapy with cisplatin and fluorouracil is the standard of care for locally advanced oesophageal cancer, but is associated with a 5-year survival of less than 40% and pathological complete remission rate of less than 5%. We present our experience with docetaxel plus cisplatin plus fluorouracil (DCF) as induction chemotherapy in patients with carcinoma of the oesophagus. Methods We undertook a retrospective analysis of a prospective database of patients with locally advanced oesophageal cancer who were referred for induction chemotherapy before surgery. All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, with no uncontrolled comorbidities. Chemotherapy consisted of 2–3 cycles of standard DCF. Growth factors and prophylactic antibiotics were administered. After chemotherapy, a restaging scan was done. If disease was judged to be resectable, surgery was undertaken. Patients were followed up after surgery and then every 3 months. Toxicity was graded according to CTCAE (version 4.03), response was calculated as per Response Evaluation Criteria in Solid Tumors (RECIST) (version 1.1), and data were reported as percentages. Findings Between February 2010 and November 2011, 17 patients had received neoadjuvant DCF. The male-to-female ratio was 1.1:1, median age was 42 years (range 21–63), and median PS was 1. Sixteen patients had squamous cancer and one had adenocarcinoma. Significant (grade 3/4) toxicities included leucopenia (41%), neutropenia (65%), febrile neutropenia (24%), diarrhoea (41%), vomiting (24%), hyponatraemia (47%), hypokalaemia (41%), fatigue (24%), and mucositis (12%). Response rates were CR 41%, PR 41%, SD 12%, and PD 6%. Eleven patients underwent R0 resections, two underwent R1/R2 resection, two were judged to have unresectable tumour and were given chemoradiotherapy, and one had CR but surgery was postponed because of hyperthyroidism. Six (35%) patients had pathological complete remission and in 1 patient carcinoma cells were seen occasionally. Interpretation In a select group of patients, DCF induces high complete pathological remission with manageable toxicity. Further assessment of DCF as a neoadjuvant regimen is warranted. The authors declared no conflicts of interest.