Selected Treatment Schedules: Adenocarcinoma, Oesophagus, Stomach

Selected Treatment Schedules

2dd, twice daily; AUC, area under the concentration–time curve; BMI, body mass index; FU, fluorouracil; HER2, human Epidermal growth factor receptor 2; FOLFIRI, folinic acid, fluorouracil and irinotecan; 5-FU, 5-fluorouracil.

Adenocarcinoma, Oesophagus

(Neo)adjuvant Palliative
Chemoradiation: weekly paclitaxel 50 mg/m2 and carboplatin AUC 2 (with radiotherapy Monday–Friday)[1] EOX: 3-weekly epirubicin 50 mg/m2, oxaliplatin 130 mg/m2, capecitabine 2dd 625 mg/m2 (every day)[5]
Chemoradiation: weekly cisplatin 25 mg/m2 and docetaxel 20 mg/m2 (with radiotherapy Monday–Friday)[3] In case of HER2 overexpression, either of the following treatment regimens:[6]
Chemoradiation: monthly cisplatin 75 mg/m2 and 5-FU 1000 mg/m2/d1-4[4]  3-weekly trastuzumab (6 mg/kg, 8 mg/kg loading dose) cisplatin 80 mg/m2, capecitabine 2dd 1000 mg/m2 d1-14
Number of administrations depends on radiation dose 3-weekly trastuzumab (6 mg/kg, 8 mg/kg loading dose) cisplatin 80 mg/m2, FU 800 mg/m2 d1-5

References

1. Shapiro J, van Lanschot JJ, Hulshof MC, et al; CROSS study group. Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 2015; 16:1090–1098.

3. Eur J Cancer 1997; 33:1216–1220. Day FL, Leong T, Ngan S, et al. Phase I trial of docetaxel, cisplatin and concurrent radical radiotherapy in locally advanced oesophageal cancer. Br J Cancer 2011; 104:265–271.

4. Minsky BD, Pajak TF, Ginsberg RJ, et al. INT 0123 (Radiation Therapy Oncology Group 94-05) phase III trial of combined-modality therapy for esophageal cancer: high-dose versus standard-dose radiation therapy. J Clin Oncol 2002; 20:1167–1174.

5. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med 2008; 358:36–46.

6. Bang Y, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376:687–697.

Adenocarcinoma, Stomach

(Neo)adjuvant Palliative
ECF: 3-weekly epirubicin 50 mg/m2, cisplatin 60 mg/m2, FU 200 mg/m2/24 h (by continuous infusion)[7] ECF: 3-weekly epirubicin 50 mg/m2, cisplatin 60 mg/m2, FU 200 mg/m2/24 h (by continuous infusion)
ECX: 3-weekly epirubicin 50 mg/m2, cisplatin 60 mg/m2, capecitabine 2dd 625 mg/m2 (every day)[8] ECX: 3-weekly epirubicin 50 mg/m2, cisplatin 60 mg/m2, capecitabine 2dd 625 mg/m2 (every day)
EOX: 3-weekly epirubicin 50 mg/m2, oxaliplatin 130 mg/m2, capecitabine 2dd 625 mg/m2 (every day)[8] EOX: 3-weekly epirubicin 50 mg/m2, oxaliplatin 130 mg/m2, capecitabine 2dd 625 mg/m2 (every day)
Note: capecitabine can also be administered d1-14 in a higher dose (1000 mg/m2 In case of HER2 overexpression, either of the following treatment regimens:
--- 3-weekly trastuzumab (6 mg/kg, 8 mg/kg loading dose), cisplatin 80 mg/m2, capecitabine 2dd 1000 mg/m2 d1-14[6]
--- 3-weekly trastuzumab (6 mg/kg, 8 mg/kg loading dose), cisplatin 80 mg/m2, FU 800 mg/m2 d1-5 

References

6. Bang Y, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet 2010; 376:687–697.

7. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med 2006; 355:11–20.

8. Sumpter K, Harper-Wynne C, Cunningham D, et al. Report of two protocol planned interim analyses in a randomised multicentre phase III study comparing capecitabine with fluorouracil and oxaliplatin with cisplatin in patients with advanced oesophagogastric cancer receiving ECF. Br J Cancer 2005; 92:1976–1983.

Last update: 08 July 2016