Chemotherapy for metastatic carcinoma of the esophagus and gastro-esophageal junction

Abstract

There is a need for well designed, adequately powered, phase III trials comparing chemotherapy versus best supportive care for patients with metastatic esophageal cancer. Chemotherapy agents with promising response rates and tolerable toxicity are cisplatin, 5-fluorouracil (5-FU), paclitaxel and antracyclins. Future trials comparing palliative treatment modalities should assess quality of life with validated quality of life measures.

Esophageal and Esophagogastric Junction Cancers

“…In randomized clinical trials, no consistent benefit was seen for any specific chemotherapy regimen, and chemotherapy showed no survival benefit compared with best supportive care for patients with advanced esophageal cancer. 190 Adequately powered phase III studies are lacking. Palliative chemotherapy is not known to provide any survival advantage, but it may improve quality of life in patients with metastatic or unresectable esophageal cancer.…”

A phase 2 study of SP1049C, doxorubicin in P-glycoprotein-targeting pluronics, in patients with advanced adenocarcinoma of the esophagus and gastroesophageal junction

“…These results have led to the use of multi-agent chemotherapy, particularly platinumand fluoropyrimidine-based chemotherapy, in the first-line setting, which has been associated further, albeit minor, clinical benefit [9][10][11][12][13][14][15][16][17][18]. More recently, the taxanes, have also been demonstrated to be active in esophageal, GEJ/ stomach cancers, and docetaxel has been registered as a component of first-line treatment for advanced gastric/GEJ cancers in many countries [13].…”

Sorafenib Triggers Antiproliferative and Pro-Apoptotic Signals in Human Esophageal Adenocarcinoma Cells

“…Despite an increasing awareness of this disease and the implementation of improved guidelines for screening and diagnosis, more than 50% of patients have an unresectable tumor at the time of diagnosis [3][4][5]. Combined aggressive surgical and chemotherapy regimens, moreover, have not changed the poor prognosis of invasive esophageal adenocarcinoma [5][6][7]. Currently overall survival figures for invasive EA do not exceed 20% at 5 years [7,8].…”