4546 - Efficacy and toxicity of weekly carboplatin and paclitaxel as induction or palliative treatment in advanced esophageal cancer patients

Background

Half of all patients with esophageal cancer present with advanced disease at diagnosis. The most optimal treatment for this group has not been identified yet. Therefore, we evaluated a weekly regimen of carboplatin for 6 cycles (area under the curve (AUC) of 4) + paclitaxel 100mg/m² as induction (iCT) or palliative treatment (pCT).

Methods

All patients with advanced (gastro-) esophageal cancer treated with this regimen between 2002-2018 at the Erasmus MC Rotterdam were included. Patients who received radiotherapy or were treated elsewhere were excluded. Data on toxicity, response, and survival were collected from patient records. Analyses were performed in 2 groups: iCT or pCT. Median progression free survival (PFS) and median overall survival (OS) were estimated with the Kaplan-Meier method.

Results

A total of 291 patients was included (iCT:122; pCT:169). Most patients had T3 carcinoma (iCT:54%; pCT:66%), and stage IV disease (iCT:42%; pCT:91%). The majority of the tumors were adenocarcinomas (iCT:50%; pCT:70%) and located at the distal esophagus (iCT:47%; pCT:73%). Incidence of severe grade ≥3 gastrointestinal toxicity was low (iCT:3%; pCT:5%). Grade ≥3 toxicity occurred mainly as hematological toxicity (iCT:71%; pCT:73%) with grade ≥3 neutropenia of 43% and grade 4 of 25% in both groups. Nonetheless, only 3% of patients experienced febrile neutropenia. Premature termination of the planned cycles due to toxicity occurred in 12% of the iCT group and 17% of the pCT group. Cycle delay due to toxicity occurred in 42% (iCT) and 43% (pCT) of the patients. Sensory neuropathy was low-graded and seen in 25% (iCT) and 26% (pCT) of the patients. Overall response rates were 48% (iCT) and 44% (pCT). Esophagectomy or definitive chemoradiotherapy followed in 42% of iCT, resulting in a PFS of 22.1 months (interquartile range (IQR): 12.4-114.2) and OS of 26.8 months (IQR: 15.4-91.7). For pCT, PFS was 8.2 months (IQR: 5.1-14.5) and OS 10.9 months (IQR: 6.5-18.3).

Conclusions

Weekly carboplatin (AUC4) and paclitaxel (100mg/m²) as an outpatient regimen is well-tolerated and an effective induction or palliative treatment regimen for patients with locally advanced or metastatic disease.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

A.H.J. Mathijssen.

Funding

Has not received any funding.

Disclosure

R.H.J. Mathijssen: Research grant / Funding (institution): Astellas; Research grant / Funding (institution): Bayer; Research grant / Funding (institution): Boehringer; Research grant / Funding (institution): Cristal Therapeutics; Research grant / Funding (institution): Novartis; Research grant / Funding (institution): Pamgene; Research grant / Funding (institution): Pfizer; Research grant / Funding (institution): Roche; Research grant / Funding (institution): Sanofi; Honoraria (institution): Servier; Honoraria (institution): Novartis; Travel / Accommodation / Expenses: Pfizer; Travel / Accommodation / Expenses: Astellas. All other authors have declared no conflicts of interest.