Preoperative Chemoradiotherapy Using Taxanes for Locally Advanced Esophageal Carcinoma
Authors: Pierre Thirion, Youri Piedbois, David J. Adelstein
Journal: Journal of Clinical Oncology (2001)

Article Tools SPECIAL DEPARTMENTS Article Tools OPTIONS & TOOLS Export Citation Track Citation Add To Favorites Rights & Permissions COMPANION ARTICLES No companion articles ARTICLE CITATION DOI: 10.1200/JCO.2001.19.6.1880 Journal of Clinical Oncology - published online before print September 21, 2016 PMID: 11251021 Preoperative Chemoradiotherapy Using Taxanes for Locally Advanced Esophageal Carcinoma Pierre ThirionxPierre ThirionSearch for articles by this author , Youri PiedboisxYouri PiedboisSearch for articles by this author David J. AdelsteinxDavid J. AdelsteinSearch for articles by this author Show More Saint Luke’s Hospital, Rathgar, Dublin, IrelandAssociation Europèenne de Récherche en Oncologie, Hôpital Albert Chenevier, Assistance Publique Hôpitaux de Paris, Paris, FranceCleveland Clinic Foundation, Cleveland, OH https://doi.org/10.1200/JCO.2001.19.6.1880 First Page Full Text PDF Figures and Tables © 2001 by American Society of Clinical OncologyjcoJ Clin OncolJournal of Clinical OncologyJCO0732-183X1527-7755American Society of Clinical OncologyResponse15032001In Reply:Drs Thirion and Piedbois have restated and reinforced our conclusions regarding the use of paclitaxel in the chemoradiotherapy of esophageal cancer.1 We agree completely with their assessment. As carefully noted several times in our article, the comparison made between the fluorouracil (5-FU) regimen and the paclitaxel regimen is nonrandomized and retrospective. These were two consecutively treated patient groups, and the limitations of this comparison were stressed. Our conclusion in the abstract and in the article is the same. A careful prospective investigation of paclitaxel-containing regimens is mandatory before the incorporation of paclitaxel into the standard management of esophageal cancer. The 5-FU and cisplatin combination has been well studied and represents the standard of care at the present time. The taxanes are interesting and active agents, but their use in this disease requires careful evaluation. As pointed out by Thirion and Piedbois, a number of phase I and II studies (including our own) have been reported or are underway, and better ways to administer this drug certainly exist. Only phase III randomized trials, however, will settle this issue.The purpose of a phase II trial is to both define the feasibility of a treatment regimen and identify whether a regimen is sufficiently promising that further study is warranted. The purpose of our article was to raise the question of whether the use of paclitaxel improves the current standard of care. Clearly we were unable to answer this question in a nonrandomized, retrospective fashion. Although the paclitaxel-containing protocol proved feasible (albeit toxic), the results were not sufficiently promising, nor were they dramatically better than those obtained with 5-FU and cisplatin. As such, we are not investigating paclitaxel further in this disease at our institution. This should not be interpreted as a recommendation to discontinue all further study of this agent. It is, however, an acknowledgement of the fact that the drug is not ready for prime-time in this disease and should not be considered part of standard chemoradiotherapy regimens.REFERENCE1. Adelstein DJ, Rice TW, Rybicki LA, et al: Does paclitaxel improve the chemoradiotherapy of locoregionally advanced esophageal cancer? A nonrandomized comparison with fluorouracil-based therapy. J Clin Oncol 18:: 2032,2000-2039, Link, Google Scholar