P-049First-line cisplatin plus bolus 5- Fluorouracil combination in patients with locally advanced and metastatic esophageal cancer

Introduction: Cancer of the esophagus typically occurs in one of two forms; upper two-thirds is a squamous cell carcinoma (SCC) and lower one-third is an adenocarcinoma. It is assumed that there are complete differences between esophageal adenocarcinomas and squamous cell cancer, such as the treatment protocol and prognosis. Cisplatin-based combinations are well reported to show high response rates (15%-53%) and median survival durations range from 3.2 to 9.8 months. Currently, cisplatin plus 5- Fluorouracil (5-FU) regimen is considered to be standard therapy for the first-line treatment of metastatic esophageal cancer patients in many centers. We evaluated the benefits and side effects of the first-line short-term infusional 5-FU and cisplatin combination regimen in patients with locally advanced and metastatic esophageal squamous cell cancer.Methods: The data of 27 patients diagnosed with locally advanced or metastatic esophageal squamous cell cancer and presenting at the Medical Oncology Clinic of Izmir Katip Celebi University Ataturk Training and Research Hospital between December 2006 and July 2013 were evaluated retrospectively. We included the patients treated with short-term infusional 5-FU and cisplatin combination, because they could not be treated with the 5-day infusion due to catheter-associated problems and social issues. Other inclusion criteria were Eastern Cooperative Oncology Group (ECOG) performance score (PS) of 0 to 2 (17) and adequate hepatic, renal, and marrow function. Chemotherapy regimen was administered as; cisplatin 75 mg/m2 on d 1, ca-leucovorin 60 mg/m2 d1-2 and 5-FU 500 mg/m2 d1-2 every 14 days.Results: There were 14 (51.9%) male and 13 (48.1%) female patients. The median age was 57 (range, 39-80) years. Twenty patients had an ECOG PS of 0 to 1 (77%), while the rest had PS of 2 (23%). Nearly half of the patients (n: 13, 48%) had moderate differentiation, 2 patients had well differentiation, 9 patients had poor differentiation and 3 patients could not be evaluated. At first diagnosis, 10 patients had distant metastases and 17 patients had localized disease. The median number of chemotherapy courses for the entire group was four (range, 2 to 12). Fourteen patients had previous surgery while 11 patients had previous radiotherapy before metastatic disease. Only 3 (11.1%) of 11 patients had adjuvant radiotherapy for R1-R2 resection after surgery while 5 (18.5%) patients had radiotherapy as neoadjuvant treatment. None had received prior chemotherapy for metastatic disease. The overall response rate was 44.4% (8 partial responses, 4 complete responses) and 7 patients (25.9%) had stable disease. The disease control rate was 70.3%. Median progression free survival was 6.2 (95% CI: 5.13–7.28) months and median overall survival was 11.1 (95% CI: 7.77-14.5) months. Among the patients, 40.7% of them had grade 3-4 neutropenia, 11.1% of those patients had grade 3-4 thrombocytopenia.Conclusion: Since short-term infusional 5-FU and cisplatin combination regimen carries a high risk for febrile neutropenia, it can be managed with primary prophylactic granulocyte colony-stimulating factor. Nevertheless, short-term infusional 5-FU and cisplatin combination regimen can be considered as an alternative treatment to an infusion regimen in which a catheter is necessary for the drug infusion. Introduction: Cancer of the esophagus typically occurs in one of two forms; upper two-thirds is a squamous cell carcinoma (SCC) and lower one-third is an adenocarcinoma. It is assumed that there are complete differences between esophageal adenocarcinomas and squamous cell cancer, such as the treatment protocol and prognosis. Cisplatin-based combinations are well reported to show high response rates (15%-53%) and median survival durations range from 3.2 to 9.8 months. Currently, cisplatin plus 5- Fluorouracil (5-FU) regimen is considered to be standard therapy for the first-line treatment of metastatic esophageal cancer patients in many centers. We evaluated the benefits and side effects of the first-line short-term infusional 5-FU and cisplatin combination regimen in patients with locally advanced and metastatic esophageal squamous cell cancer. Methods: The data of 27 patients diagnosed with locally advanced or metastatic esophageal squamous cell cancer and presenting at the Medical Oncology Clinic of Izmir Katip Celebi University Ataturk Training and Research Hospital between December 2006 and July 2013 were evaluated retrospectively. We included the patients treated with short-term infusional 5-FU and cisplatin combination, because they could not be treated with the 5-day infusion due to catheter-associated problems and social issues. Other inclusion criteria were Eastern Cooperative Oncology Group (ECOG) performance score (PS) of 0 to 2 (17) and adequate hepatic, renal, and marrow function. Chemotherapy regimen was administered as; cisplatin 75 mg/m2 on d 1, ca-leucovorin 60 mg/m2 d1-2 and 5-FU 500 mg/m2 d1-2 every 14 days. Results: There were 14 (51.9%) male and 13 (48.1%) female patients. The median age was 57 (range, 39-80) years. Twenty patients had an ECOG PS of 0 to 1 (77%), while the rest had PS of 2 (23%). Nearly half of the patients (n: 13, 48%) had moderate differentiation, 2 patients had well differentiation, 9 patients had poor differentiation and 3 patients could not be evaluated. At first diagnosis, 10 patients had distant metastases and 17 patients had localized disease. The median number of chemotherapy courses for the entire group was four (range, 2 to 12). Fourteen patients had previous surgery while 11 patients had previous radiotherapy before metastatic disease. Only 3 (11.1%) of 11 patients had adjuvant radiotherapy for R1-R2 resection after surgery while 5 (18.5%) patients had radiotherapy as neoadjuvant treatment. None had received prior chemotherapy for metastatic disease. The overall response rate was 44.4% (8 partial responses, 4 complete responses) and 7 patients (25.9%) had stable disease. The disease control rate was 70.3%. Median progression free survival was 6.2 (95% CI: 5.13–7.28) months and median overall survival was 11.1 (95% CI: 7.77-14.5) months. Among the patients, 40.7% of them had grade 3-4 neutropenia, 11.1% of those patients had grade 3-4 thrombocytopenia. Conclusion: Since short-term infusional 5-FU and cisplatin combination regimen carries a high risk for febrile neutropenia, it can be managed with primary prophylactic granulocyte colony-stimulating factor. Nevertheless, short-term infusional 5-FU and cisplatin combination regimen can be considered as an alternative treatment to an infusion regimen in which a catheter is necessary for the drug infusion.