EL4 - Current Evidence of Chemotherapy for Esophageal Cancer

Abstract

Chemotherapy is used in many ways for the treatment of esophageal cancer. It has been used not only in the form of systemic chemotherapy but also in the form of definitive chemoradiotherapy and preoperative chemo(radio)therapy. In the JCOG9906 clinical trial, 5-fluorouracil plus cisplatin (FP) and concurrent radiotherapy (RT, 60 Gy) was used as definitive chemoradiotherapy, but this was changed to FP plus RT (50.4 Gy), a regimen that has the advantages of less late toxicities and the possibility of salvage therapy. Currently, this regimen is being evaluated in the JCOG0909 study. As per the JCOG9907 results, 2 courses of FP followed by surgery can be used as standard treatment. In addition, the superiority of docetaxel in combination with FP (DCF), and superiority of RT (41.4 Gy) with FP compared with preoperative FP is being verified in a randomized control trial (JCOG1109, NExT trial). Over the last 2 decades, FP therapy has remained the standard treatment for metastatic or recurrent esophageal cancer, but recently, taxanes have been used as second-line treatment. Evaluation of DCF (biweekly docetaxel with FP) in JCOG0807 indicated good results. Phase III trial, JCOG1314, compared FP to biweekly DCF regimen is planning now. Cetuximab, an anti-epidermal growth factor receptor antibody, was evaluated in a chemoradiotherapy setting, but there was no additive effect of cetuximab to standard chemoradiothearpy. Research for the exploration of new molecular targets is expected to help in the development of novel targeted therapy.