Objective To determine the feasibility and toxicity of the addition of cetuximab to paclitaxel, cisplatin, and concurrent intensity modulated radiation therapy (IMRT) for patients with esophageal squamous cell carcinoma (ESCC). Methods Nineteen patients with stage Ⅰ to Ⅲ ESCC, without distant organ metastases, were eligible. All patients received cetuximab, an initial dose of 400 mg/m2 in the first week followed by weekly injection of 250 mg/m2, paclitaxel 45 mg/m2 and cisplatin 20 mg/m2 weekly for 7 weeks with IMRT of 59.4 Gy/33 fractions. Results Two patients discontinued because of severe adverse events. Seventeen patients completed the planned treatment protocol. Of whom, 12 patients achieved completeremission. The objective response rate was 100%. A median follow-up time was 29.3 months. The 1-year overall survival and recurrence-free survival rate was 100% and 82%, respectively. Main toxicities including myelosuppression, esophagitis and skin rash happened in 19 patients. Grade ≥2 neutropenia, esophagitis and skin toxicity noted rates was 89%,84% and 58%,respectively. Local recurrence was found in two patients. Neck lymph node and lung metastasis found in one patient. Conclusions Cetuximab, when combined with paclitaxel, cisplatin and IMRT, is efficient and safe for esophageal squamous cell carcinoma, Further clinical study is needed.
HE Chun-yu*,BU Shan-shan,ZHANG Jing-wei et al. Clinical study of cetuximab combined with concurrent chemoradiotherapy for esophageal squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2012, 21(6): 518-521.
[1] Cunningham D, Humblet Y, Siena S, et al. Cetuximab monotherapy and cetuximab plus irinotecan in irinotecan-refractory metastatic colorectal cancer. N Engl J Med,2004,351:337-345. [2] Bonner JA, Harari PM, Giralt J, et al. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med,2006,354:567-578. [3] Pirker R, Pereira JR, Szczesna A, et al. Cetuximab plus chemotherapy in patients with advanced non-small cell lung cancer (FLEX):an open label randomized phase Ⅲ trial. Lancet,2009,373:1525-1531. [4] 中国非手术治疗食管癌临床分期专家小组.非手术治疗食管癌的临床分期标准.中华放射肿瘤学杂志,2010,19:179-180. [5] Enzinger PC, Mayer RJ. Esophageal cancer. N Engl J Med,2003,349:2241-2252. [6] Cooper JS, Guo MD, Herskovic A, et al. Chemoradiotherapy of locally advanced esophageal cancer:long-term follow-up of a prospective randomized trial (RTOG 85-01). JAMA,1999,281:1623-1627. [7] Minsky BD, Pajak TF, Ginsberg RJ, et al. INT0123(RTOG 94-05) phase Ⅲ trial of combined-modality therapy for esophageal cancer:high dose versus standard-dose radiation therapy. J Clin Oncol,2002,20:1167-1174. [8] Wong R, Mahhaner R.Combined chemotherapy and radiotherapy (without surgery) compared with radiotherapy alone in localized carcinoma of the esophagus.Cochrane Database Syst Rev,2006,(1):CD002092.
[9] 刘俊,吕长兴,王家明. 同期放化疗治疗不能手术的食管癌临床结果.中华放射肿瘤学杂志,2006,15:185-187. [10] Swisher SG, Winter KA, Komaki RU, et al. A Phase Ⅱ study of a paclitaxel-based chemoradiation regimen with selective surgical salvage for resectable locoregionally advanced esophageal cancer:initial reporting of RTOG 0246.Int J Radiat Oncol Biol Phys.2012,82:1967-1972. [11] Ajani JA, Winter K, Komaki R, et al. Phase Ⅱ randomized trial of two nonoperative regimens of induction chemotherapy followed by chemoradiation in patients with localized carcinoma of the esophagus:RTOG 0113. J Clin Oncol, 2008,26:1-6. [12] Hanawa M, Suzuki S, Dobashi Y, et al. EGFR protein overexpression and gene amplification in squamous cell carcinomas of the esophagus. Int J Cancer, 2006,118:1173-1180. [13] Liang K, Ang KK, Milas L, et al. The epidermal growth factor receptor mediates radioresistance. Int J Radiat Oncol Biol Phys,2003,57:246-254. [14] Milas L, Fan Z, Andratschke NH, et al. Epidermal growth factor receptor and tumor response to radiation:in vivo preclinical studies. Int J Radiat Oncol Biol Phys,2004,58:966-971. [15] Safran H, Suntharalingam M, Dipetrillo T, et al. Cetuximab with concurrent chemoradiation for esophagogastric cancer:assessment of toxicity. Int J Radiat Oncol Biol Phys,2008,70:391-395. [16] Ruhstaller T, Pless M, Schuller J, et al. Cetuximab in combination with chemoradiotherapy prior to surgery in patients with resectable, locally advanced esophageal carcinoma:a prospective, multicenter phase Ⅰb-Ⅱ trial of the swiss group for clinical cancer research (SAKK 75/06). J Clin Oncol,2009,27:4570. [17] Zemanova M, Petruzelka L, Pazdro A, et al. Prospective non-randomized study of preoperative concurrent platinum plus 5-fluorouracil-based chemoradiotherapy with or without paclitaxel in esophageal cancer patients:long-term follow-up. Dis Esophagus,2010,23:160-167. [18] Higuchi K, Koizumi W, Tanabe S, et al. A phase Ⅰ trial of definitive chemoradiotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF-R) for advanced esophageal carcinoma:Kitasato digestive disease & oncology group trial (KDOG 0501). Radiother Oncol,2008,87:398-404.