Definitive Chemoradiation with Concurrent Weekly Cisplatin in the Treatment of Esophageal Squamous Cell Carcinoma – A Simplistic Approach

2021 ◽  
Vol 6 (2) ◽  
pp. 181-187
Author(s):  
Imtiaz Ahmed ◽  
Sapna Krishnamurthy ◽  
Rohan Bhise
Keyword(s):  
Squamous Cell ◽  
Treatment Time ◽  
Univariate Analysis ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Response To Treatment ◽  
Prolonged Treatment ◽  
Weekly Chemotherapy ◽  
Weekly Cisplatin

Purpose: Chemoradiation is the standard of care in locally advanced/ inoperable esophageal squamous cell cancer (ESCC). Though combination chemotherapy with Cisplatin and 5-Fluorouracil is the standard, it has low compliance due to toxicities and prolonged treatment time. Hence there is a window of opportunity to explore a safer chemotherapy regimen without compromising the treatment outcome. Methods: 55 patients of ESCC who were treated with definitive External Beam Radiotherapy (EBRT) to a dose of 50.4 – 59.4 Gray and concurrent weekly Cisplatin (or Carboplatin) were retrospectively evaluated for treatment efficacy and outcomes. 2 year Overall Survival (OS) and Progression Free Survival (PFS) were evaluated. Prognostic variables were assessed with respect to OS in Univariate analysis. Results: Median age at presentation was 58 years. 29 (53%) had lesion in the upper third of esophagus. 40 (72%) had T3 disease and 31 (56%) were node positive. All patients (100%) completed planned radiotherapy dose. 54 (98%) received 4 or more cycles of weekly chemotherapy. Mean overall treatment time was 43 days. Only 7 patients (12.7%) had grade 3 or more acute toxicity. 36 (65.5%) had complete response. At median follow-up of 13.7 months, the median OS was 15.2 months and 2 year OS was 42.6%. On univariate analysis, patients with comorbidities and lower third lesion had poor OS (p=0.016 and p=0.002). Stage II disease and complete response to treatment showed better OS (p=0.02 and p=0.00). Conclusion: Radical chemoradiation with weekly Cisplatin in ESCC is a simple and effective regimen which needs to be explored in larger trials.

Cetuximab, paclitaxel, carboplatin and radiation for esophageal and gastric cancer

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 4029-4029 ◽  
Author(s):  
M. Suntharalingam ◽  
T. Dipetrillo ◽  
P. Akerman ◽  
H. Wanebo ◽  
B. Daly ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Esophageal Cancer ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Grade 3

4029 Background: Cetuximab is an IgG1, chimerized, monoclonal antibody that binds specifically to the epidermal growth factor receptor. Cetuximab improves survival when combined with radiation for patients with locally advanced head and neck cancer. We evaluated the safety and efficacy of the addition of cetuximab to concurrent chemoradiation for patients with esophageal and gastric cancer. Methods: Patients with adenocarcinoma or squamous cell cancer of the esophagus or stomach without distant organ metastases were eligible. Patients with locally advanced disease from mediastinal, celiac, portal and gastric lymphadenopathy were eligible. Surgical resection was not required. Clinical complete response was defined as no tumor on postreatment endoscopic biopsy. Patients received cetuximab, 400mg/m2 week #1 then 250 mg/m2/week for 5 weeks, paclitaxel, 50 mg/m2/week, and carboplatin, AUC =2 weekly for 6 weeks, with concurrent 50.4 Gy radiation. Results: Thirty-seven patients have been entered. The median age was 61 (range of 30–87). Thirty-four have esophageal cancer and 3 have gastric cancer. Of the patients with esophageal cancer, twenty-five have adenocarcinoma and nine have squamous cell cancer. Thus far, 30 patients have completed treatment and are evaluable for toxicity. There have been no grade 4 non-hematologic toxicities and 1 pt had grade 4 neutropenia (3%). Six patients (20%) had grade 3 esophagitis. Other grade 3 toxicities included dehydration (n=5), rash (n=9), and paclitaxel/cetuximab hypersensitivity reactions (n=2). Eighteen of 27 patients (67%) have had clinical complete response. Seven pts out of 16 (43%) who have gone to surgery have had a pathologic CR. Conclusions: Cetuximab can be safely administered with chemoradiation for patients with esophageal cancer. Consistent with the data in head and neck cancer, cetuximab increases cutaneous toxicity but does not increase mucositis/esophagitis when combined with chemoradiation. Further evaluation is ongoing. [Table: see text]

scholarly journals A comparative study of radical radiotherapy with weekly paclitaxel versus radical radiotherapy with weekly cisplatin in the management of locally advanced squamous cell carcinomas of head and neck

2017 ◽  
Vol 5 (2) ◽  
pp. 473
Author(s):  
Ram Madhavan ◽  
Bhaskar P.K ◽  
Antonoitte Mary Nithiya ◽  
Janarthina Kani ◽  
Madhu Mathi ◽  
...  
Keyword(s):  
Partial Response ◽  
Head And Neck ◽  
Squamous Cell ◽  
Locally Advanced ◽  
Complete Response ◽  
Squamous Cell Carcinomas ◽  
Weekly Paclitaxel ◽  
Radiation Dermatitis ◽  
Radical Radiotherapy ◽  
Weekly Cisplatin

Background: Concurrent chemo radiation is standard of care in locally advanced squamous cell carcinomas of head and neck. Single agent Cisplatin either weekly or three weekly is commonly used concurrently with radiation. The present study aims to evaluate the response rate and toxicity of radical radiotherapy with weekly paclitaxel and cisplatin in head and neck cancers.Methods: This is a prospective double arm study in which sixty patients with histologically proved squamous cell carcinomas registered in our department were accrued into the study with thirty patients in each arm. All patients were treated using Theratron phoenix 780 cobalt unit with a dose of 66 Gy in 33 fractions. The patients were randomized to receive 40 mg/m2 of weekly cisplatin or 40 mg/m2 of weekly Paclitaxel concurrently with radiation. The response to the therapy was assessed six weeks after completion of treatment. The statistical analysis was done using SPSS software.Results: In cisplatin group 18 patients achieved complete response and 12 patients achieved partial response whereas in Paclitaxel group 21 patients achieved complete response and 9 patients achieved partial response. However in paclitaxel arm the incidence of radiation dermatitis, mucositis, dysphagia and laryngitis are slightly higher compared to cisplatin group.Conclusions: The weekly paclitaxel concurrent with radiation is a feasible alternative to weekly cisplatin in locally advanced squamous cell carcinomas of head and neck.

Efficacy and safety of single agent pan-HER inhibitor dacomitinib in locally advanced unresectable or metastatic skin squamous cell cancer (sSCC).

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. 9543-9543 ◽  
Author(s):  
Paolo Bossi ◽  
Stefano Cavalieri ◽  
Federica Perrone ◽  
Rosalba Miceli ◽  
Paolo Antonio Ascierto ◽  
...  
Keyword(s):  
Skin Rash ◽  
Squamous Cell ◽  
Squamous Cell Cancer ◽  
Cell Cancer ◽  
Single Agent ◽  
Locally Advanced ◽  
Complete Response ◽  
Palliative Intent ◽  
Duration Of Response ◽  
Ecog Ps

9543 Background: In recurrent/metastatic skin squamous cell cancer (sSCC) not amenable to radiotherapy (RT) or surgery, chemotherapy (CT) has a palliative intent and limited clinical responses. We investigated the role of pan-HER inhibitor dacomitinib within a phase II trial in this setting. Methods: Patients (pts) with diagnosis of sSCC not amenable to curative approaches were included. Oral dacomitinib was started at a dose of 30 mg daily for 15 days, followed by 45 mg daily. Primary endpoint was response rate (RR). Tumor samples were analyzed through Next Generation Sequencing methods (pgm, Ion torrent) using a custom panel targeting 36 genes associated with sSCC. Results: Forty-two pts (33 M, 9 F; median age 77 years, range 45-92) were treated. ECOG PS was 0 in 58%, 1 in 40% and 2 in 2%. One fifth of the pts had distant metastasis. Most pts (86%) received previous treatments consisting in surgery (86%), RT (50%) and CT (14%). Among evaluable pts, overall RR was 28% (complete response CR 2%, partial response PR 26%), disease control rate 86%. Median duration of response was 11 months (range 1-26+). Median treatment duration was 4 months (range 1-26+). Reason for discontinuation were disease progression in 69%, adverse events (AEs) in 19%, non drug-related death in 5%; 3 pts are still on treatment. Median PFS and OS were 6 and 12 months, respectively. Most pts (93%) had at least one AE, mainly consisting in diarrhea and skin rash (71% each), fatigue (36%) and stomatitis (31%). G3/G4 AEs occurred in 36% of pts (diarrhea and skin rash 17% each). Tumor material was available from 7 responding (R: 6 PR, 1 CR) and 15 non-responding (NR: 13SD, 2PD) pts. Frequent TP53 (60%), NOTCH1/2 (60%) and FAT1 (40%) mutations were observed. NR pts showed a higher occurrence of HRAS/BRAF/NRAS mutations (40%) than R ones (28%). Moreover, HER3 (27%) CASP8 (27%), KMT2C (33%) and DCLK1 (27%) mutations were restricted to NR pts. Conclusions: In sSCC dacomitinib showed activity, similar to what observed with anti-EGFR monoclonal antibody cetuximab and panitumumab (RR 28% and 31%); safety profile was comparable to previous experiences in other diseases. Molecular pt selection could improve therapeutic ratio. Clinical trial information: NCT02268747.

scholarly journals Squamous cell carcinoma of the rectum: Practice trends and patient survival.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 625-625
Author(s):  
Sunil W Dutta ◽  
Clayton E Alonso ◽  
Mark Raymond Waddle ◽  
Shiv R. Khandelwal ◽  
Einsley-Marie Janowski ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Neoadjuvant Therapy ◽  
Squamous Cell ◽  
Cell Cancer ◽  
Locally Advanced ◽  
Complete Response ◽  
Trimodality Therapy ◽  
Locally Advanced Tumors ◽  
Advanced Tumors

625 Background: Leverage the National Cancer Database (NCDB) to evaluate trends in management of squamous cell cancer (SCC) of the rectum and their effect on survival for this uncommon tumor. Methods: Data was obtained from the NCDB for patients diagnosed with SCC of the rectum between 2004 and 2014, including cT1-4, cN0-2, cM0 (cohort A, n = 2,296) tumors. A subgroup analysis was performed on locally advanced tumors (cT1-T2, N+ or cT3, N any, subcohort B, n = 883), treated with chemoradiation (n = 706) or trimodality therapy (n = 177) including chemotherapy, radiation, and surgery. Pathological complete response rate following neoadjuvant therapy was obtained. Univariate and multivariate logistic regression analyses were performed to generate hazard ratios (HR) investigating factors associated with overall survival. Kaplan-Meier (K-M) method was used to estimate overall surviving proportion at 5 and 10 years. Results: The median age was 60 years with a strong female predilection (71% female). Among patients treated with neoadjuvant therapy, 36% achieved a complete pathological response at a median interval of 67 days from completion of radiation therapy to surgery. The K-M estimated 5 and 10 year overall survival for stage I disease was 71.3% and 57.8%, respectively; stage II disease was 57.0% and 38.9%, respectively; stage III disease was 57.8% and 41.5%, respectively. On multivariate analysis, increased age, male gender, more co-morbidities, and higher cT category ( P < 0.001 for each) resulted in worse survival. For locally advanced tumors (subcohort B), there was no difference in survival between chemoradiation alone compared to trimodality therapy ( P = 0.909 on multivariate analysis). Conclusions: Most providers manage locally advanced SCC of the rectum similar to anal cancer, which results in equivalent overall survival and spares patients from the additional morbidity associated with surgical resection. [Table: see text]

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