For patients with distal esophageal adenocarcinoma who are not surgical candidates, how do you decide between the preferred chemotherapy regimens when given as definitive chemo-radiation?

Topics: Gastrointestinal Cancers • Esophageal Cancer • Medical Oncology

Preferred options in NCCN guidelines: 5FU+cisplatin, 5FU+oxaliplatin, paclitaxel+carboplatin?

Answer from: Medical Oncologist at Academic Institution

My regimen of choice has fluctuated over the years. At MSKCC, our institutional standard was previously cisplatin/irinotecan (Ilson, Cancer 2012). This was abandoned after the results of the CROSS study were presented in 2010, establishing a global benchmark for tolerability and a highly respectable...

Comments

Medical Oncologist at Norton Cancer Institute
Thank you for such a thoughtful response.

Medical Oncologist at Florida Cancer Specialists and Research Institute
Thank you @Geoffrey Y. Ku for an excellent and tho...

Medical Oncologist at Florida Cancer Specialists and Research Institute
@Geoffrey Y. Ku For GE junction adenocarcinoma sie...

Medical Oncologist at Memorial Sloan Kettering Cancer Center
No, I wouldn't consider induction FLOT prior to ch...

Answer from: Medical Oncologist at Academic Institution

There are no randomized data to guide this decision. Multiple retrospective studies indicate that carboplatin/paclitaxel is similar in efficacy to cisplatin/5-FU with less toxicity. Consequently, I favor weekly carboplatin/paclitaxel for neoadjuvant and definitive chemoradiation. As @Geoffrey Y...

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