Comparing Chemotherapy Options for Patients With Esophageal Squamous Cell Carcinoma

For patients with locally advanced oesophageal squamous cell carcinoma (OSCC), the current recommended treatment is neoadjuvant therapy, despite many patients experiencing a poor prognosis.

Prior research has demonstrated that patients with OSCC may require more intensive neoadjuvant therapy.

A study from Ken Kato, MD, PhD, and colleagues published in The Lancet sought to determine the safety and efficacy of neoadjuvant doublet chemotherapy, triplet chemotherapy, and doublet chemotherapy plus radiotherapy in patients with locally advanced OSCC.

In the phase 3, randomized study, patients received neoadjuvant doublet chemotherapy (fluorouracil 800 mg/m², cisplatin 80 mg/m² [NeoCF]), triplet chemotherapy (fluorouracil 750 mg/m², cisplatin 70 mg/m², docetaxel 70 mg/m² [NeoCF+D]), or doublet chemotherapy (fluorouracil 1000 mg/m², cisplatin 75 mg/m²) plus radiotherapy 41.4 Gy (NeoCF+RT) followed by oesophagectomy with regional lymph node dissection.

Dr. Kato and colleagues reported that the NeoCF+D cohort experienced a higher 3-year overall survival (OS) rate than those in the NeoCF cohort after a median follow-up of 50.7 months.

In the NeoCF group, 2 (1%) patients demonstrated grade 3 or higher febrile neutropenia, compared with 32 (16%) in the NeoCF+D group and 9 (5%) in the NeoCF+RT group. Treatment-related adverse events resulting in treatment termination were reported more often in the NeoCF+D cohort (n=18) than in the NeoCF+RT (n=12) and NeoCF (n=8) cohorts.

Three (2%) treatment-related deaths were reported during neoadjuvant therapy in the NeoCF cohort, 4 (2%) in the NeoCF+D cohort, and 2 (1%) in the NeoCF+RT cohort.

“Neoadjuvant triplet chemotherapy followed by oesophagectomy resulted in a statistically significant [OS] benefit compared with doublet chemotherapy and might be the new standard of care for [patients with] locally advanced OSCC who are in good condition in Japan,” the researchers wrote. “Neoadjuvant doublet chemotherapy plus radiotherapy did not show significant improvement of survival compared with doublet chemotherapy.”