Anterior chemotherapy in esophageal cancer

Abstract

Front loading chemotherapy using methotrexate (200 mg/m2) alone or methotrexate (200 mg/m2) with cisplatin (20 mg/m2 daily for 5 days) was used in epidermoid carcinoma of esophagus. Evaluation after two courses showed objective response of 50% or greater in 48% of patients with methotrexate alone. Response rate was increased to 76.2% with addition of cisplatin to methotrexate. Small lesions (less than 10 cm) showed better response as compared to advanced cases. Therapy was generally well tolerated and good palliation was obtained even after the first course. Postchemotherpy treatment either with surgery or radiotherapy was tolerated without any major complications. The data confirm the short-term usefulness of initial chemotherapy with methotrexate and cisplatin in esophageal cancer. Results of prolonged follow-up will help to evaluate the role of front loading chemotherapy on long-term survival.

A pragmatic randomised controlled trial of the cost-effectiveness of palliative therapies for patients with inoperable oesophageal cancer

“…102,[120][121][122] The most favourable response rates are with cisplatin-based combinations: responses with single-agent therapy such as bleomycin, methotrexate, 5-FU, and vindesine do not exceed 30%, but rise to 30-60% when cisplatin is added. 33,39,123,124 However, response is not a good indicator of clinical effect, which may be short lived, and toxicity is always a problem. This is demonstrated by Bleiberg and colleagues, who randomised patients with locally advanced or metastatic squamous oesophageal cancer to cisplatin alone or in combination with 5-FU; the response rate was 35% for combination chemotherapy versus 19% for cisplatin alone, but this did not translate into a survival advantage and toxicity was frequent and severe with combination treatment, with seven treatment-related deaths (16%).…”

Neoadjuvant cis‐DDP in esophageal cancers: An experience at a regional cancer centre, India

“…Short-term encouraging results of pre-operative chemotherapy in esophageal cancers have been published [7]. There are differences between the trials in patient selection, operative approach, and chemotherapy regimens.…”

Combined Treatment Modalities in Esophageal Cancer: Should chemotherapy be included?

“…At least 12 chemotherapeutic drugs have been tested as single agents. Response rates over 20% can be calculated, when several trials are compiled, for five drugs: cisplatinum (20 responses/86 evaluable patients), methotrexate (23/67), mitoguazone (MGBG) (9/45), mitomycin-C ( 1 5/58) and vindesine (28/ 83) (1,(28)(29)(30). Of the responses, however, very few are complete remissions (CR) (28).…”