Preoperative docetaxel, cisplatin, and 5-fluorouracil for resectable locally advanced esophageal and esophagogastric junctional adenocarcinoma

• Published in: Esophagus : official journal of the Japan Esophageal Society 2024-07, Vol.21 (3), p.328-335
• Main Authors: Hirose, Toshiharu, Yamamoto, Shun, Honma, Yoshitaka, Yokoyama, Kazuki, Hirano, Hidekazu, Okita, Natsuko, Shoji, Hirokazu, Iwasa, Satoru, Takashima, Atsuo, Ishiyama, Koshiro, Oguma, Junya, Daiko, Hiroyuki, Maeda, Shin, Kato, Ken
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - drug therapy; Adenocarcinoma - pathology; Adenocarcinoma - surgery; Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols - administration & dosage; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Cancer; Chemotherapy; Cisplatin - administration & dosage; Cisplatin - therapeutic use; Docetaxel - administration & dosage; Docetaxel - therapeutic use; Esophageal Neoplasms - drug therapy; Esophageal Neoplasms - pathology; Esophageal Neoplasms - surgery; Esophagectomy - methods; Esophagogastric Junction - pathology; Esophagus; Female; Fluorouracil - administration & dosage; Fluorouracil - therapeutic use; Gastroenterology; Humans; Japan - epidemiology; Male; Medicine; Medicine & Public Health; Middle Aged; Neoadjuvant Therapy - methods; Neutropenia; Original; Original Article; Retrospective Studies; Stomach Neoplasms - drug therapy; Stomach Neoplasms - pathology; Stomach Neoplasms - surgery; Surgical Oncology; Thoracic Surgery; Treatment Outcome
• ISSN: 1612-9059; 1612-9067; 1612-9067
• DOI: 10.1007/s10388-024-01050-2

Background Chemotherapy consisting of 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel is the standard perioperative treatment for resectable esophageal adenocarcinoma and esophagogastric junctional adenocarcinoma (EGJ-AC) in Western countries. Meanwhile, preoperative chemotherapy consisting of docetaxel, cisplatin, and 5-fluorouracil (DCF) has been developed for esophageal squamous cell carcinoma in Japan. However, there are few reports on the safety and efficacy of preoperative DCF for resectable EGJ-AC in the Japanese population. Methods Patients with histologically confirmed resectable EGJ-AC who received preoperative DCF (docetaxel 70 mg/m 2 and cisplatin 70 mg/m 2 on day 1 and continuous infusion of 5-fluorouracil 750 mg/m 2 /day on days 1–5 every 3 weeks with a maximum of three cycles) between January 2015 and April 2020 were retrospectively evaluated. We assessed the rates of completion of ≥ 2 courses of DCF and R0 resection, histopathological response, progression-free survival (PFS), overall survival (OS), and adverse events. Results Thirty-two patients were included. Median follow-up was 28.7 (range, 5.2–70.8) months and median age was 63 (range, 42–80) years. Twenty-one patients (66%) had a performance status of 0. The proportions of clinical stage IIA/IIB/III/IVA/IVB disease were 3%/0%/44%/44%/9%, respectively. The treatment completion rate was 84%. A histopathological response of grade 1a/1b/2/3 was obtained in 58%/26%/13%/3% of cases. Median PFS was 40.7 months (95% confidence interval 11.8-NA). Median OS was not reached (80.8% at 3 years). Grade ≥ 3 adverse events were observed in 63% of cases (neutropenia, 44%; febrile neutropenia, 13%). No treatment-related deaths occurred. Conclusions Preoperative DCF for resectable EGJ-AC was well tolerated and has promising efficacy.