From the Guidelines
Paclitaxel 60 mg/m² on day 1 with Carboplatin AUC 2 IV on day 1 is a viable regimen for chemoradiotherapy (CRT) treatment of gastroesophageal junction cancer, as supported by the Dutch trial 1. This regimen has been shown to provide a beneficial effect in patients with oesophago-gastric junctional cancer, with a median OS of 19.3 months compared to 17.7 months for those randomised to surgery alone 1.
Key Considerations
- The combination of paclitaxel and carboplatin provides radiosensitization while maintaining a tolerable side effect profile compared to more intensive regimens.
- Patients should be monitored for myelosuppression, particularly neutropenia and thrombocytopenia, as well as peripheral neuropathy from paclitaxel.
- Adequate antiemetic prophylaxis and premedication with dexamethasone, diphenhydramine, and H2 blockers before paclitaxel administration are essential to prevent hypersensitivity reactions.
Benefits and Risks
- The beneficial effect of this regimen is more pronounced in patients with squamous cell carcinoma (HR 0.34; 95% CI 0.17 to 0.65) compared with adenocarcinoma (HR 0.82; 95% CI 0.58 to 1.16) 1.
- However, the regimen is associated with higher perioperative morbidity, and patients should be informed of the potential high risks and poor outcomes 1.
Administration and Monitoring
- This weekly regimen is typically administered concurrently with radiation therapy for 5-6 weeks.
- Patients should be closely monitored for adverse effects, and dose adjustments should be made as necessary to minimize toxicity while maintaining efficacy.
From the Research
Efficacy of Paclitaxel and Carboplatin in CRT Treatment
- The combination of paclitaxel and carboplatin has been studied as a potential treatment for esophageal cancer, including gastroesophageal junction cancer 2, 3, 4, 5, 6.
- A phase II study found that paclitaxel and carboplatin with radiation was well tolerated and had promising efficacy for patients with esophageal cancer 2.
- Another study compared the outcomes of paclitaxel and carboplatin with cisplatin and fluorouracil in concurrent chemoradiotherapy for esophageal or gastroesophageal junction cancer, and found that the two regimens had similar overall survival and disease-free survival rates in the setting of trimodality therapy, but cisplatin and fluorouracil may be superior in definitive chemoradiotherapy 3.
- A randomized clinical trial compared the efficacy and adverse events of three paclitaxel-based regimens, including paclitaxel with carboplatin, and found that the regimens had similar overall survival rates, but the cisplatin group had higher incidences of acute grade 3 or 4 neutropenia, thrombocytopenia, anemia, fatigue, and vomiting 5.
Dosage and Administration
- The dosage of paclitaxel and carboplatin used in the studies varied, but common dosages included paclitaxel 30 mg/m² twice weekly for 10 doses, and carboplatin AUC 1.5 weekly for five doses 2.
- Another study used paclitaxel 60 mg/m² on day 1, and carboplatin AUC 2 on day 1, which is the dosage mentioned in the question 4.
- The studies used different administration schedules, including weekly and every 3 weeks 2, 5, 6.
Toxicity and Safety
- The combination of paclitaxel and carboplatin was generally well tolerated, but common toxicities included nausea, esophagitis, neutropenia, neuropathy, and fatigue 2, 3, 5, 6.
- Grade III or greater toxicity occurred in 26.1% of patients in one study, with the most common grade III toxicities being neutropenia and neuropathy 6.