Top

Published in:

06-07-2022 | Esophageal Cancer | Original Article

Neoadjuvant chemotherapy for locally advanced esophageal cancer comparing cisplatin and 5-fluorouracil versus docetaxel plus cisplatin and 5-fluorouracil: a propensity score matching analysis

Authors: Noriyuki Nishiwaki, Kazuhiro Noma, Tomoyoshi Kunitomo, Masashi Hashimoto, Naoaki Maeda, Shunsuke Tanabe, Kazufumi Sakurama, Yasuhiro Shirakawa, Toshiyoshi Fujiwara

Published in: Esophagus | Issue 4/2022

Abstract

Background

The standard treatment for locally advanced esophageal cancer is preoperative chemotherapy with cisplatin and 5-fluorouracil (CF), followed by surgery. Although docetaxel plus cisplatin and 5-fluorouracil (DCF) has been reported to have favorable outcomes, no study has compared its therapeutic efficacy to that of standard treatment. This study aimed to compare the therapeutic effects of CF and DCF in the real world by matching patient background factors using propensity scores.

Methods

We retrospectively reviewed the data of 237 patients with esophageal squamous cell carcinoma who underwent esophagectomy between January 2008 and December 2018. Patients were divided into two groups based on the preoperative chemotherapy regimens of CF (79 patients) or DCF (158 patients), and 49 matched pairs were finally analyzed using propensity score matching. Short- and long-term outcomes were compared between groups.

Results

After matching, although no significant differences in survival were observed among the groups, patients receiving DCF showed a significantly high histological response (P < 0.001). Subgroup analyses demonstrated that DCF therapy had better overall survival (P = 0.046) and relapse-free survival (P = 0.010) among pathological T3 and T4 cases. Whereas, adverse effects of chemotherapy were more frequent in the DCF group.

Conclusions

Patients receiving DCF had higher pathological response and better survival than those receiving CF, especially in pathological T3 and T4 cases matched using propensity scores. Thus, the DCF regimen might be an effective treatment for locally advanced esophageal cancer. However, the adverse side effects of chemotherapy remain high and should be handled appropriately.

Available only for authorised users

Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492.CrossRefPubMed

Lagergren J, Smyth E, Cunningham D, et al. Oesophageal cancer. Lancet. 2017;390:2383–96. https://doi.org/10.1016/S0140-6736(17)31462-9.CrossRefPubMed

Ando N, Kato H, Igaki H, et al. A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907). Ann Surg Oncol. 2012;19:68–74. https://doi.org/10.1245/s10434-011-2049-9.CrossRefPubMed

Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 1. Esophagus. 2019;16:1–24. https://doi.org/10.1007/s10388-018-0641-9.CrossRefPubMed

Kitagawa Y, Uno T, Oyama T, et al. Esophageal cancer practice guidelines 2017 edited by the Japan esophageal society: part 2. Esophagus. 2019;16:25–43. https://doi.org/10.1007/s10388-018-0642-8.CrossRefPubMed

Ando N, Iizuka T, Ide H, et al. Surgery plus chemotherapy compared with surgery alone for localized squamous cell carcinoma of the thoracic esophagus: a Japan clinical oncology group study–JCOG9204. J Clin Oncol. 2003;21:4592–6. https://doi.org/10.1200/JCO.2003.12.095.CrossRefPubMed

Yokota T, Hatooka S, Ura T, et al. Docetaxel plus 5-fluorouracil and cisplatin (DCF) induction chemotherapy for locally advanced borderline-resectable T4 esophageal cancer. Anticancer Res. 2011;31:3535–41.PubMed

Hashimoto M, Shirakawa Y, Maeda N, et al. Induction chemoradiotherapy including docetaxel, cisplatin, and 5-fluorouracil for locally advanced esophageal cancer. Esophagus. 2020;17:127–34. https://doi.org/10.1007/s10388-019-00709-5.CrossRefPubMed

Yokota T, Kato K, Hamamoto Y, et al. Phase II study of chemoselection with docetaxel plus cisplatin and 5-fluorouracil induction chemotherapy and subsequent conversion surgery for locally advanced unresectable oesophageal cancer. Br J Cancer. 2016;115:1328–34. https://doi.org/10.1038/bjc.2016.350.CrossRefPubMedPubMedCentral

10.

Yokota T, Kato K, Hamamoto Y, et al. A 3-year overall survival update from a phase 2 study of chemoselection with DCF and subsequent conversion surgery for locally advanced unresectable esophageal cancer. Ann Surg Oncol. 2020;27:460–7. https://doi.org/10.1245/s10434-019-07654-8.CrossRefPubMed

11.

Kato K, Ito Y, Daiko H, et al. A randomized controlled phase III trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer JCOG1109 NExT study. J Clin Oncol. 2022;40:238. https://doi.org/10.1200/JCO.2022.40.4_suppl.238.CrossRef

12.

Austin PC. Optimal caliper widths for propensity-score matching when estimating differences in means and differences in proportions in observational studies. Pharm Stat. 2011;10:150–61. https://doi.org/10.1002/pst.433.CrossRefPubMed

13.

Daiko H, Kato K. Updates in the 8th edtion of the TNM staging system for esophagus and esophagogastric junction cancer. Jpn J Clin Oncol. 2020;50:847–51.CrossRef

14.

Japan esophageal society. Japanese classification of esophageal cancer. 11th ed. Esophagus 2017;14:1–36.

15.

Japan esophageal society. Japanese classification of esophageal cancer: II and III. 11th ed. Esophagus 2017;14:37–65.

16.

Health U do SH. Common Terminol Criteria Adverse Events (CTCAE). 2017 Accessed 27 Nov 2017. https://ctep.cancer.gov/protocolDevelopment/electronic_applications/docs/CTCAE_v5_Quick_Reference_5x7.pdf;5:0

17.

Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13. https://doi.org/10.1097/01.sla.0000133083.54934.ae.CrossRefPubMedPubMedCentral

18.

Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant. 2013;48:452–8. https://doi.org/10.1038/bmt.2012.244.CrossRefPubMed

19.

Sobin LH, Gospodarowicz MK, Wittekind C. TNM classification of malignant tumours. 7th ed. Chichester, West Sussex, UK: Wiley-Blackwell; 2010.

20.

Sobin LH, Wittekind C, editors. TNM classification of malignant tumors. 6th ed. New York: Wiley-Liss; 2002.

21.

Lei N, Song Z, Lu B, et al. Docetaxel-based therapy with and without antiangiogenic agents as first-line chemotherapy for castration-resistant prostate cancer: a meta-analysis of nine randomized controlled trials. Mol Clin Oncol. 2014;2:1182–8. https://doi.org/10.3892/mco.2014.404.CrossRefPubMedPubMedCentral

22.

Blom JW, Vanderschoot JP, Oostindiër MJ, et al. Incidence of venous thrombosis in a large cohort of 66,329 cancer patients: results of a record linkage study. J Thromb Haemost. 2006;4:529–35. https://doi.org/10.1111/j.1538-7836.2006.01804.x.CrossRefPubMed

23.

Haddad TC, Greeno EW. Chemotherapy-induced thrombosis. Thromb Res. 2006;118:555–68. https://doi.org/10.1016/j.thromres.2005.10.015.CrossRefPubMed

24.

Hamza MS, Mousa SA. Cancer-associated thrombosis: risk factors, molecular mechanisms, future management. Clin Appl Thromb Hemost. 2020;26:1076029620954282. https://doi.org/10.1177/1076029620954282.CrossRefPubMedPubMedCentral

25.

Lechner D, Kollars M, Gleiss A, et al. Chemotherapy-induced thrombin generation via procoagulant endothelial microparticles is independent of tissue factor activity. J Thromb Haemost. 2007;5:2445–52. https://doi.org/10.1111/j.1538-7836.2007.02788.x.CrossRefPubMed

26.

Feffer SE, Carmosino LS, Fox RL. Acquired protein C deficiency in patients with breast cancer receiving cyclophosphamide, methotrexate, and 5-fluorouracil. Cancer. 1989;63:1303–7. https://doi.org/10.1002/1097-0142(19890401)63:7%3c1303::aid-cncr2820630713%3e3.0.co;2-f.CrossRefPubMed

27.

Guo W, Ma X, Yang S, et al. Combined thoracoscopic-laparoscopic esophagectomy versus open esophagectomy: a meta-analysis of outcomes. Surg Endosc. 2016;30:3873–81. https://doi.org/10.1007/s00464-015-4692-x.CrossRefPubMed

28.

Booka E, Haneda R, Ishii K, et al. The negative impact of preoperative chemotherapy on survival after esophagectomy for vulnerable elderly patients with esophageal cancer. Ann Surg Oncol. 2021;28:1786–95. https://doi.org/10.1245/s10434-020-09072-7.CrossRefPubMed

Title: Neoadjuvant chemotherapy for locally advanced esophageal cancer comparing cisplatin and 5-fluorouracil versus docetaxel plus cisplatin and 5-fluorouracil: a propensity score matching analysis
Authors: Noriyuki Nishiwaki
Kazuhiro Noma
Tomoyoshi Kunitomo
Masashi Hashimoto
Naoaki Maeda
Shunsuke Tanabe
Kazufumi Sakurama
Yasuhiro Shirakawa
Toshiyoshi Fujiwara
Publication date: 06-07-2022
Publisher: Springer Nature Singapore
Keywords: Esophageal Cancer
Esophageal Cancer
Cytostatic Therapy
Published in: Esophagus / Issue 4/2022
Print ISSN: 1612-9059
Electronic ISSN: 1612-9067
DOI: https://doi.org/10.1007/s10388-022-00934-5

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 4/2022

A phase II study of S-1 therapy for patients with advanced and recurrent esophageal cancer resistant or intolerable to fluorouracil, platinum, and taxane therapy (OGSG 1404)

Correction to: Esophageal cancer practice guidelines 2017 edited by the Japan Esophageal Society: part 1 and Part 2

Phase II study of BKM120 in patients with advanced esophageal squamous cell carcinoma (EPOC1303)

Patterns of failure after salvage chemoradiotherapy for postoperative loco-regional recurrent esophageal cancer: 20-year experience in a single institution in Japan

Oral metronomic chemotherapy after definitive chemoradiation in esophageal squamous cell carcinoma: a randomized clinical trial

Real-world treatment patterns and outcomes in Japanese patients with cervical esophageal cancer

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials