From the Guidelines
The preferred chemotherapy regimen for chemoradiotherapy (CRT) in gastroesophageal cancer is 5-FU and cisplatin (CF), as established by the RTOG 85-01 trial and confirmed by subsequent studies 1. This regimen has been shown to improve median survival and 5-year overall survival (OS) rates compared to radiation therapy alone. The standard dose of radiation therapy is 50.4 Gy, as higher doses have not been shown to improve outcomes in trials such as INT 0123 1. Some key points to consider when using this regimen include:
- 5-FU and cisplatin are administered concurrently with radiation therapy
- The choice of chemotherapy regimen may depend on patient factors, including performance status and comorbidities
- Other regimens, such as docetaxel and cisplatin, or carboplatin and paclitaxel, may also be effective, but 5-FU and cisplatin remain the standard of care based on the most recent and highest quality evidence 1. The efficacy of definitive chemoradiation with CF has been confirmed in recent reports, with high overall response rates and median OS times of up to 23 months 1. While other regimens, such as FOLFOX4, may be considered for patients who are not candidates for surgery, 5-FU and cisplatin remain the preferred choice for CRT in gastroesophageal cancer due to their established efficacy and safety profile 1.
From the Research
Chemotherapy Regimens for Gastroesophageal Cancer
The preferred chemotherapy regimen for concurrent chemoradiation therapy (CRT) in gastroesophageal cancer is a topic of ongoing research. Several studies have compared the efficacy and toxicity of different regimens, including:
- Cisplatin/5-fluorouracil (5-FU) vs. carboplatin/paclitaxel 2, 3, 4, 5
- Weekly chemotherapy with 5-FU and cisplatin concurrent with radiotherapy 6
Efficacy of Chemotherapy Regimens
The studies suggest that:
- Carboplatin/paclitaxel and cisplatin/5-FU have comparable overall survival (OS) and disease-free survival (DFS) rates in esophageal cancer patients 2, 3
- Cisplatin/5-FU is associated with increased pathologic complete response and improved survival compared to carboplatin/paclitaxel in locally advanced esophageal cancer 4
- Paclitaxel and carboplatin have better survival outcomes and lower treatment-related toxicities compared to cisplatin and 5-FU in concurrent chemoradiotherapy for esophageal cancer 5
Toxicity of Chemotherapy Regimens
The studies also report that:
- Carboplatin/paclitaxel has lower hematological and non-hematological toxicity rates compared to cisplatin/5-FU 2, 3
- Weekly chemotherapy with 5-FU and cisplatin concurrent with radiotherapy has improved toxicity profiles compared to once every 3 weeks chemotherapy regimen 6