Esophageal cancer - historical

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The purpose of this page is to provide references to regimens that are obsolete, outdated, or of historical interest only. Is there a regimen missing from this list? See the main esophageal cancer page for current regimens.
Last updated on 2024-12-28:1 regimens on this page
1 variants on this page
 
=Neoadjuvant induction therapy=
==FLEP==
FLEP: Fluorouracil, Leucovorin, Etoposide, Platinol (Cisplatin)
===Regimen===
Study 	Dates of enrollment	Evidence
Stahl et al. 2005	1994-2002 	Non-randomized part of phase 3 RCT
Note: For historic reference.
====Chemotherapy====
*Fluorouracil (5-FU) 500 mg/m2 IV once per day on days 1 to 3
*Leucovorin (Folinic acid) 300 mg/m2 IV once per day on days 1 to 3
*Etoposide (Vepesid) 100 mg/m2 IV once per day on days 1 to 3
*Cisplatin (Platinol) 30 mg/m2 IV once per day on days 1 to 3
21-day cycle for 3 cycles
====Subsequent treatment====
*Neoadjuvant PE & RT (4000 cGy) followed by surgery versus definitive PE & RT (at least 6500 cGy)
===References===
#Stahl M, Stuschke M, Lehmann N, Meyer HJ, Walz MK, Seeber S, Klump B, Budach W, Teichmann R, Schmitt M, Schmitt G, Franke C, Wilke H. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005 Apr 1;23(10):2310-7. Erratum in: J Clin Oncol. 2006 Jan 20;24(3):531. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
=Definitive therapy=
==Radiation therapy==
===Regimen variant #1, 5000 cGy===
Study 	Dates of enrollment	Evidence 	Comparator	Comparative Efficacy
Herskovic et al. 1992 (RTOG 85-01)	1986-1990 	Phase 3 (C)	CF & RT 	Shorter OS
Note: Patients had 88% squamous cell, 12% adenocarcinoma histology. 7% Karnofsky performance scale of 50-60. Radiation was used as primary therapy; used as a comparator arm and here for reference purposes only.
====Radiotherapy====
*External beam radiotherapy total of 32 fractions: 5000 cGy of regional treatment and 1400 cGy to the boost field, for total dose of 6400 cGy
6.4-week course
===Regimen variant #2, 6000 cGy===
Study 	Dates of enrollment 	Evidence 	Comparator	Comparative Efficacy
Ji et al. 2021 (ZJCH-E-E)	2016-06-01 to 2018-08-31	Phase 3 (C)	S-1 & RT 	Shorter OS24
====Radiotherapy====
*External beam radiotherapy 200 cGy per day, 5 days per week, for 30 fractions (total dose of 6000 cGy)
One course
===References===
#RTOG 85-01: Herskovic A, Martz K, al-Sarraf M, Leichman L, Brindle J, Vaitkevicius V, Cooper J, Byhardt R, Davis L, Emami B. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Engl J Med. 1992 Jun 11;326(24):1593-8. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
##Update: al-Sarraf M, Martz K, Herskovic A, Leichman L, Brindle JS, Vaitkevicius VK, Cooper J, Byhardt R, Davis L, Emami B. Progress report of combined chemoradiotherapy versus radiotherapy alone in patients with esophageal cancer: an intergroup study. J Clin Oncol. 1997 Jan;15(1):277-84. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
##Update: Cooper JS, Guo MD, Herskovic A, Macdonald JS, Martenson JA Jr, Al-Sarraf M, Byhardt R, Russell AH, Beitler JJ, Spencer S, Asbell SO, Graham MV, Leichman LL; Radiation Therapy Oncology Group. Chemoradiotherapy of locally advanced esophageal cancer: long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA. 1999 May 5;281(17):1623-7. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
#ZJCH-E-E: Ji Y, Du X, Zhu W, Yang Y, Ma J, Zhang L, Li J, Tao H, Xia J, Yang H, Huang J, Bao Y, Du D, Liu D, Wang X, Li C, Yang X, Zeng M, Liu Z, Zheng W, Pu J, Chen J, Hu W, Li P, Wang J, Xu Y, Zheng X, Chen J, Wang W, Tao G, Cai J, Zhao J, Zhu J, Jiang M, Yan Y, Xu G, Bu S, Song B, Xie K, Huang S, Zheng Y, Sheng L, Lai X, Chen Y, Cheng L, Hu X, Ji W, Fang M, Kong Y, Yu X, Li H, Li R, Shi L, Shen W, Zhu C, Lv J, Huang R, He H, Chen M. Efficacy of Concurrent Chemoradiotherapy With S-1 vs Radiotherapy Alone for Older Patients With Esophageal Cancer: A Multicenter Randomized Phase 3 Clinical Trial. JAMA Oncol. 2021 Oct 1;7(10):1459-1466. link to original article link to PMC article dosing details in manuscript have been reviewed by our editors EuroPMC NCT02813967
=Metastatic or locally advanced disease, subsequent lines of therapy=
==Gefitinib monotherapy==
===Regimen===
Study 	Dates of enrollment 	Evidence 	Comparator	Comparative Efficacy
Ferry et al. 2007 	2002-03-13 to 2003-07-08	Phase 2 	 	ORR: 11.1%, 95% CI 2.4-29.2
Dutton et al. 2014 (COG-esoph)	2009-2011 	Phase 3 (E-esc)	Placebo 	Did not meet primary endpoint of OSMedian OS: 3.73 vs 3.67 mo(HR 0.90, 95% CI 0.74-1.09)
Note: COG is renamed as COG-esoph so as not to confuse with the Children's Oncology Group.
COG-esoph patients: 24% squamous cell, 76% adenocarcinoma histology. 78% esophageal, 22% gastroesophageal junction
====Targeted therapy====
*Gefitinib (Iressa) 500 mg PO once per day on days 1 to 28
28-day cycles
===References===
#Ferry DR, Anderson M, Beddard K, Tomlinson S, Atherfold P, Obszynska J, Harrison R, Jankowski J. A phase II study of gefitinib monotherapy in advanced esophageal adenocarcinoma: evidence of gene expression, cellular, and clinical response. Clin Cancer Res. 2007 Oct 1;13(19):5869-75. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC
#COG-esoph: Dutton SJ, Ferry DR, Blazeby JM, Abbas H, Dahle-Smith A, Mansoor W, Thompson J, Harrison M, Chatterjee A, Falk S, Garcia-Alonso A, Fyfe DW, Hubner RA, Gamble T, Peachey L, Davoudianfar M, Pearson SR, Julier P, Jankowski J, Kerr R, Petty RD. Gefitinib for oesophageal cancer progressing after chemotherapy (COG): a phase 3, multicentre, double-blind, placebo-controlled randomised trial. Lancet Oncol. 2014 Jul;15(8):894-904. Epub 2014 Jun 17. link to original article dosing details in manuscript have been reviewed by our editors EuroPMC NCT01243398
Category:Esophageal cancer regimens
Category:Historical regimens
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Category:Gastroesophageal cancers