Top Line: What is the ideal concurrent systemic therapy when delivering definitive chemoradiation for esophageal squamous cell carcinoma?
The Study: Paclitaxel plus carboplatin and fluorouracil plus oxaliplatin are the preferred concurrent regimens by the NCCN for locally advanced ESCC. Cisplatin and fluorouracil is a category 1 option, but it is less preferred due to toxicity. There’s also the question of replacing fluorouracil with capecitabine given its ease of administration. In this randomized trial, 246 patients receiving definitive chemoradiation for locally advanced, unresectable ESCC at multiple Chinese centers were randomized to 50 Gy in 25 fractions with cisplatin + fluorouracil (PF), capecitabine + oxaliplatin (XELOX), or capecitabine alone (X). Patients in each arm were also randomized to receive 2 additional cycles of the same consolidative chemotherapy or not. The study was designed to determine if the capecitabine arms were superior to PF. At 2 years, there were no differences in OS (70.9% v 66.7% v 75%). The complete response rates were 33.3%, 37.6%, and 35%. Grade 3+ toxicity was higher with PF (45.7%) followed by XELOX (36.5%) and X (28.8%). With respect to the secondary randomization, patients who received consolidative chemo had significantly higher median OS (41.9 v 36.9 months).
TBL: In this randomized trial, concurrent capecitabine alone and capecitabine plus oxaliplatin did not improve survival compared to cisplatin and fluorouracil, but they did have less toxicity. Survival was better among patients in each arm who received additional consolidative chemo after chemoradiation. | Jia, J Clin Oncol 2024
The Study: Paclitaxel plus carboplatin and fluorouracil plus oxaliplatin are the preferred concurrent regimens by the NCCN for locally advanced ESCC. Cisplatin and fluorouracil is a category 1 option, but it is less preferred due to toxicity. There’s also the question of replacing fluorouracil with capecitabine given its ease of administration. In this randomized trial, 246 patients receiving definitive chemoradiation for locally advanced, unresectable ESCC at multiple Chinese centers were randomized to 50 Gy in 25 fractions with cisplatin + fluorouracil (PF), capecitabine + oxaliplatin (XELOX), or capecitabine alone (X). Patients in each arm were also randomized to receive 2 additional cycles of the same consolidative chemotherapy or not. The study was designed to determine if the capecitabine arms were superior to PF. At 2 years, there were no differences in OS (70.9% v 66.7% v 75%). The complete response rates were 33.3%, 37.6%, and 35%. Grade 3+ toxicity was higher with PF (45.7%) followed by XELOX (36.5%) and X (28.8%). With respect to the secondary randomization, patients who received consolidative chemo had significantly higher median OS (41.9 v 36.9 months).
TBL: In this randomized trial, concurrent capecitabine alone and capecitabine plus oxaliplatin did not improve survival compared to cisplatin and fluorouracil, but they did have less toxicity. Survival was better among patients in each arm who received additional consolidative chemo after chemoradiation. | Jia, J Clin Oncol 2024