• Chemotherapy for Esophageal Cancer

    Cancer chemotherapy is the use of drugs to kill cancer cells. Unlike radiation and surgery, which are localized treatments, chemotherapy is a systemic treatment, meaning the drugs travel throughout the whole body. This means chemotherapy can reach cancer cells that may have spread, or metastasized, to other areas.
    Multiple trials of chemotherapy for esophageal cancer have produced up to a 50% response rate. However, the responses are short-lived and have neither cured nor improved long-term survival. Response rates do not differ between squamous cell and adenocarcinoma.

    Chemotherapy Drugs Used for Esophageal Cancer

    Practically every type of chemotherapeutic agent has been used to treat esophageal cancer. Among the more successful are:
    • 5-fluorouracil (5-FU)
    • Cisplatin (Platinol-AQ)
    • Docetaxel (Taxotere)
    • Irinotecan (Camptosar)
    • Mitomycin (Mutamycin)
    • Paclitaxel (Taxol, Onxol)
    • Vindesine (Eldisine)
    • Vinorelbine (Navelbine)
    Effectiveness
    Single agent chemotherapy has produced brief responses in 15% to 30% of patients. Combination treatment with a cisplatin-based combination of two or three agents, either alone or as a prelude to surgery , has resulted in response rates up to 50%, but with no clear increase in survival. Combining chemotherapy with radiation and/or surgery has also failed to produce a clearly preferable treatment regimen.
    Platinum Coordination Complexes
    Platinum-based drugs used for chemotherapy include the following:
    • Carboplatin (Paraplatin)
    • Cisplatin (Platinol-AQ)
    Cisplatin is used alone for esophageal cancer and in combination with paclitaxel to treat advanced disease. Due to its lower toxicity, carboplatin is being tested as a substitute for cisplatin in this combination.
    Possible side effects of platinum coordination complexes include:
    • Life-threatening allergic reactions
    • Kidney damage
    • Hearing loss
    • Low blood counts
    • Liver damage
    • Nerve damage
    • Blood vessel damage
    • Hair loss
    Antibiotics
    Common name: mitomycin (Mutamycin)
    Mitomycin is used alone or in combination to treat esophageal cancer.
    Possible side effects of anticancer antibiotics include:
    • Low blood counts (most common and severe)
    • Rashes
    • Hair loss
    • Injection site inflammation
    • Kidney damage
    • Lung damage
    • Fever
    • Nausea
    • Vomiting
    Antimetabolites
    Common name: 5-fluorouracil (5-FU)
    5-FU is one of several chemotherapeutic agents commonly used to treat carcinomas. It can be used alone or in combination.
    Possible side effects of antimetabolites include:
    • Mouth and throat inflammation
    • Low blood counts
    • Severe allergic reactions
    • Visual impairment
    • Liver damage
    • Fever
    • Nosebleeds
    • Weakness
    • Confusion
    • Headache
    • Heart pain (angina)
    • Nausea
    • Vomiting
    • Diarrhea
    • Stomach ulcers
    • Discoloration of skin
    Taxanes
    Common names include:
    • Docetaxel (Taxotere)
    • Paclitaxel (Taxol, Onxol)
    Paclitaxel combined with cisplatin or carboplatin is a favored regimen for treating esophageal cancer. It produces complete disease regression in about 25% of patients with Stage III disease. Large studies to support its superiority over other chemotherapy drugs have not been performed.
    Docetaxel works similarly to paclitaxel and appears to be at least as effective.
    Possible side effects of taxanes include:
    • Life-threatening allergic reactions
    • Low blood pressure
    • Heart damage (slowing of the heart rate)
    • Low blood counts
    • Nerve damage
    • Nausea
    • Vomiting
    • Diarrhea
    • Unusual infections
    • Edema (swelling)
    Vinca Alkaloids
    Common names include:
    • Vindesine (Eldisine)
    • Vinorelbine (Navelbine)
    Vindesine and vinorelbine are newer derivatives of vinblastine that appear to be effective even when vinblastine and vincristine are not.
    Possible side effects of vindesine and vinorelbine include:
    • Bone marrow damage
    • Nerve damage
    • Headache
    • Face pain
    • Nausea, vomiting, diarrhea, constipation
    • Liver damage
    • Inflammation of the mouth
    • Fever
    • Hair loss
    • Rashes
    • Muscle damage
    DNA Topoisomerase Inhibitors
    Common name: irinotecan (Camptosar)
    This type of drug damages DNA during cell replication. Since cancer cells replicate faster than healthy cells, the effect is concentrated in tumor tissue. Irinotecan has shown promise in single agent treatment of esophageal cancer and in combinations.
    Possible side effects of irinotecan include:
    • Low blood counts
    • Nausea, vomiting, diarrhea, constipation, abdominal pain
    • Liver damage
    • Blood clots
    • Low blood pressure
    • Breathing problems
    • Inflammation of the mouth
    • Dizziness
    • Sleepiness
    • Insomnia
    • Fever
    • Headache
    • Hair loss
    • Rashes

    References

    Drug Facts & Comparisons. Facts & Comparisons; 2000.

    Esophageal cancer. National Cancer Institute website. Available at: http://www.nci.nih.gov/cancerinfo/wyntk/esophagus . Accessed December 2, 2002.

    Harrison's Principles of Internal Medicine. 14th ed. McGraw-Hill; 1998.

    Neoplasms of the esophagus. American Cancer Society website. Available at http://www.cancer.org/docroot/home/index.asp . Accessed November 30, 2002.

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