Esophageal cancer: no advantage in swapping cisplatin for paclitaxel

  • Chen Y & al.
  • J Clin Oncol
  • 28 Mar 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • In patients with esophageal squamous cell carcinoma, fluorouracil plus paclitaxel instead of cisplatin offers no survival benefit in patients receiving definitive concurrent chemoradiotherapy (dCRT).

Why this matters

  • Regimens with paclitaxel have been used in concurrent chemotherapy “for several decades … despite the lack of level 1 evidence,” the authors say.
  • They suggest that fluorouracil and cisplatin remain the standard regimen in these patients.

Key results

  • Median follow-up: 48.7 (interquartile range, 42.6-60.9) months.
  • 3-year OS: 
    • 55.4% with paclitaxel vs 51.8% with cisplatin;
    • HR, 0.905 (P=.448).
  • 3-year PFS also did not differ:
    • 43.7% with paclitaxel vs 45.5% cisplatin; 
    • HR, 0.973 (P=.828).
  • Paclitaxel group had lower incidence of some adverse events (e.g., anorexia, nausea, vomiting, fatigue) but higher incidence of others (≥grade 3 leukopenia, radiation dermatitis, radiation pneumonitis).

Study design

  • 436 patients at 6 centers randomly allocated to paclitaxel or cisplatin groups.
  • 138 and 152 completed, respectively.
  • Primary endpoint: 3-year OS.
  • Funding: National Natural Science Foundation of China.

Limitations

  • Different paclitaxel regimens not compared.

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