Skip to main content

Advertisement

Log in

A phase I study evaluating combined nimotuzumab and neoadjuvant chemoradiotherapy followed by surgery in locally advanced esophageal cancer

  • Original Article
  • Published:
Cancer Chemotherapy and Pharmacology Aims and scope Submit manuscript

Abstract

Objective

The aim of this study was to evaluate the safety and efficacy of combined nimotuzumab and neoadjuvant chemoradiotherapy followed by surgery in locally advanced esophageal cancer.

Methods

Patients with clinically resectable, locally advanced esophageal cancer treated with neoadjuvant chemoradiotherapy plus nimotuzumab were eligible for study participation. Radiotherapy was administered in 1.8 Gy once daily for 5 days per week up to a total dose of 41.4 Gy. Weekly nimotuzumab (200 mg/week) was administered following paclitaxel and carboplatin on the same day for 5 weeks. The primary end-point was the pathological complete response (pCR) rate and the secondary end-point was the safety, progression-free survival (PFS) and overall survival (OS).

Results

A total of 64 patients with a median age of 58 years were enrolled in this study. pCR was observed in 51.6% patients. Grade 3 acute toxicities were observed in 6 patients (9.4%), shown as bone marrow suppression. 7 patients experienced grade 1 transient skin rash during nimotuzumab treatment. The median PFS time and OS time were 64.6 and 68.2 months.

Conclusions

Combined nimotuzumab and neoadjuvant chemoradiotherapy for clinically resectable, locally advanced esophageal cancer showed a significant anticancer effect with tolerable toxicities.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Huang TC, Hsu CH, Lin CC, Tu YK (2015) Systematic review and network meta-analysis: neoadjuvant chemoradiotherapy for locoregional esophageal cancer. Jpn J Clin Oncol 45(11):1023–1028. https://doi.org/10.1093/jjco/hyv119

    Article  PubMed  Google Scholar 

  2. van Hagen P, Hulshof MC, van Lanschot JJ, Steyerberg EW, van Berge Henegouwen MI, Wijnhoven BP, Richel DJ, Nieuwenhuijzen GA, Hospers GA, Bonenkamp JJ, Cuesta MA, Blaisse RJ, Busch OR, ten Kate FJ, Creemers GJ, Punt CJ, Plukker JT, Verheul HM, Spillenaar Bilgen EJ, van Dekken H, van der Sangen MJ, Rozema T, Biermann K, Beukema JC, Piet AH, van Rij CM, Reinders JG, Tilanus HW, van der Gaast A, Group C (2012) Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med 366(22):2074–2084

    Article  PubMed  Google Scholar 

  3. Zhen Y, Guanghui L, Xiefu Z (2014) Knockdown of EGFR inhibits growth and invasion of gastric cancer cells. Cancer Gene Ther 21(11):491–497. https://doi.org/10.1038/cgt.2014.55

    Article  CAS  PubMed  Google Scholar 

  4. Song J, Shi W, Zhang Y, Sun M, Liang X, Zheng S (2016) Epidermal growth factor receptor and B7-H3 expression in esophageal squamous tissues correlate to patient prognosis. OncoTargets Ther 9:6257–6263. https://doi.org/10.2147/OTT.S111691

    Article  CAS  Google Scholar 

  5. Yu W, Yang X, Chu L, Zhao K, Chen H, Xiang J, Zhang Y, Li H, Zhao W, Sun M, Wei Q, Fu X, Xie C, Zhu Z (2018) Prognostic value of EGFR family expression in lymph node-negative esophageal squamous cell carcinoma patients. Pathol Res Pract 214(7):1017–1023. https://doi.org/10.1016/j.prp.2018.04.017

    Article  CAS  PubMed  Google Scholar 

  6. Suntharalingam M, Winter K, Ilson D, Dicker AP, Kachnic L, Konski A, Chakravarthy AB, Anker CJ, Thakrar H, Horiba N, Dubey A, Greenberger JS, Raben A, Giguere J, Roof K, Videtic G, Pollock J, Safran H, Crane CH (2017) Effect of the addition of cetuximab to paclitaxel, cisplatin, and radiation therapy for patients with esophageal cancer: the NRG oncology RTOG 0436 phase 3 randomized clinical trial. JAMA Oncol 3(11):1520–1528. https://doi.org/10.1001/jamaoncol.2017.1598

    Article  PubMed  PubMed Central  Google Scholar 

  7. Janjigian YY, Ku GY, Campbell JC, Shah MA, Capanu M, Kelsen DP, Ilson DH (2014) Phase II trial of cetuximab plus cisplatin and irinotecan in patients with cisplatin and irinotecan-refractory metastatic esophagogastric cancer. Am J Clin Oncol 37(2):126–130. https://doi.org/10.1097/COC.0b013e318271b14f

    Article  CAS  PubMed  Google Scholar 

  8. Ilson DH, Kelsen D, Shah M, Schwartz G, Levine DA, Boyd J, Capanu M, Miron B, Klimstra D (2011) A phase 2 trial of erlotinib in patients with previously treated squamous cell and adenocarcinoma of the esophagus. Cancer 117(7):1409–1414. https://doi.org/10.1002/cncr.25602

    Article  CAS  PubMed  Google Scholar 

  9. Mazorra Z, Chao L, Lavastida A, Sanchez B, Ramos M, Iznaga N, Crombet T (2018) Nimotuzumab: beyond the EGFR signaling cascade inhibition. Semin Oncol 45(1–2):18–26. https://doi.org/10.1053/j.seminoncol.2018.04.008

    Article  CAS  PubMed  Google Scholar 

  10. Zhao L, He LR, Xi M, Cai MY, Shen JX, Li QQ, Liao YJ, Qian D, Feng ZZ, Zeng YX, Xie D, Liu MZ (2012) Nimotuzumab promotes radiosensitivity of EGFR-overexpression esophageal squamous cell carcinoma cells by upregulating IGFBP-3. J Transl Med 10:249. https://doi.org/10.1186/1479-5876-10-249

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Kato K, Ura T, Koizumi W, Iwasa S, Katada C, Azuma M, Ishikura S, Nakao Y, Onuma H, Muro K (2018) Nimotuzumab combined with concurrent chemoradiotherapy in Japanese patients with esophageal cancer: a phase I study. Cancer Sci 109(3):785–793. https://doi.org/10.1111/cas.13481

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Liang J, Mingyan E, Wu G, Zhao L, Li X, Xiu X, Li N, Chen B, Hui Z, Lv J, Fang H, Tang Y, Bi N, Wang W, Zhai Y, Li T, Chen D, Zou S, Lu N, Perez-Rodriguez R, Zheng J, Wang L (2013) Nimotuzumab combined with radiotherapy for esophageal cancer: preliminary study of a Phase II clinical trial. OncoTargets Ther 6:1589–1596. https://doi.org/10.2147/ott.s50945

    Article  CAS  Google Scholar 

  13. de Castro Junior G, Segalla JG, de Azevedo SJ, Andrade CJ, Grabarz D, de Araujo Lima Franca B, Del Giglio A, Lazaretti NS, Alvares MN, Pedrini JL, Kussumoto C, de Matos Neto JN, Forones NM, Fernandes Junior HJ, Borges G, Girotto G, da Silva I, Maluf-Filho F, Skare NG (2018) A randomised phase II study of chemoradiotherapy with or without nimotuzumab in locally advanced oesophageal cancer: NICE trial. Eur J Cancer 88:21–30. https://doi.org/10.1016/j.ejca.2017.10.005

    Article  CAS  Google Scholar 

  14. Mariette C, Piessen G, Briez N, Triboulet JP (2008) The number of metastatic lymph nodes and the ratio between metastatic and examined lymph nodes are independent prognostic factors in esophageal cancer regardless of neoadjuvant chemoradiation or lymphadenectomy extent. Ann Surg 247(2):365–371. https://doi.org/10.1097/SLA.0b013e31815aaadf

    Article  PubMed  Google Scholar 

  15. Shapiro J, van Lanschot JJB, Hulshof M, van Hagen P, van Berge Henegouwen MI, Wijnhoven BPL, van Laarhoven HWM, Nieuwenhuijzen GAP, Hospers GAP, Bonenkamp JJ, Cuesta MA, Blaisse RJB, Busch ORC, Ten Kate FJW, Creemers GM, Punt CJA, Plukker JTM, Verheul HMW, Bilgen EJS, van Dekken H, van der Sangen MJC, Rozema T, Biermann K, Beukema JC, Piet AHM, van Rij CM, Reinders JG, Tilanus HW, Steyerberg EW, van der Gaast A, Group Cs, (2015) Neoadjuvant chemoradiotherapy plus surgery versus surgery alone for oesophageal or junctional cancer (CROSS): long-term results of a randomised controlled trial. Lancet Oncol 16(9):1090–1098. https://doi.org/10.1016/S1470-2045(15)00040-6

    Article  PubMed  Google Scholar 

  16. Yang H, Liu H, Chen Y, Zhu C, Fang W, Yu Z, Mao W, Xiang J, Han Y, Chen Z, Yang H, Wang J, Pang Q, Zheng X, Yang H, Li T, Lordick F, D’Journo XB, Cerfolio RJ, Korst RJ, Novoa NM, Swanson SJ, Brunelli A, Ismail M, Fernando HC, Zhang X, Li Q, Wang G, Chen B, Mao T, Kong M, Guo X, Lin T, Liu M, Fu J, Group AMETSC (2018) Neoadjuvant chemoradiotherapy followed by surgery versus surgery alone for locally advanced squamous cell carcinoma of the esophagus (NEOCRTEC5010): a Phase III multicenter, randomized, open-label clinical trial. J Clin Oncol 36(27):2796–2803. https://doi.org/10.1200/jco.2018.79.1483

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Zhao KL, Hu XC, Wu XH, Fu XL, Fan M, Jiang GL (2012) A phase I dose escalation study of Nimotuzumab in combination with concurrent chemoradiation for patients with locally advanced squamous cell carcinoma of esophagus. Invest New Drugs 30(4):1585–1590. https://doi.org/10.1007/s10637-011-9735-0

    Article  CAS  PubMed  Google Scholar 

  18. Ramos-Suzarte M, Lorenzo-Luaces P, Lazo NG, Perez ML, Soriano JL, Gonzalez CE, Hernadez IM, Albuerne YA, Moreno BP, Alvarez ES, Callejo IP, Alert J, Martell JA, Gonzalez YS, Gonzalez YS, Astudillo de la Vega H, Ruiz-Garcia EB, Ramos TC (2012) Treatment of malignant, non-resectable, epithelial origin esophageal tumours with the humanized anti-epidermal growth factor antibody nimotuzumab combined with radiation therapy and chemotherapy. Cancer Biol Ther 13(8):600–605. https://doi.org/10.4161/cbt.19849

    Article  CAS  PubMed  Google Scholar 

  19. Ma NY, Cai XW, Fu XL, Li Y, Zhou XY, Wu XH, Hu XC, Fan M, Xiang JQ, Zhang YW, Chen HQ, Lai ST, Jiang GL, Zhao KL (2014) Safety and efficacy of nimotuzumab in combination with radiotherapy for patients with squamous cell carcinoma of the esophagus. Int J Clin Oncol 19(2):297–302. https://doi.org/10.1007/s10147-013-0564-3

    Article  CAS  PubMed  Google Scholar 

  20. Ling Y, Chen J, Tao M, Chu X, Zhang X (2012) A pilot study of nimotuzumab combined with cisplatin and 5-FU in patients with advanced esophageal squamous cell carcinoma. J Thorac Dis 4(1):58–62. https://doi.org/10.3978/j.issn.2072-1439.2011.08.02

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Wang C, Fu X, Cai X, Wu X, Hu X, Fan M, Xiang J, Zhang Y, Chen H, Jiang G, Zhao K (2016) High-dose nimotuzumab improves the survival rate of esophageal cancer patients who underwent radiotherapy. OncoTargets Ther 9:117–122. https://doi.org/10.2147/OTT.S89592

    Article  CAS  Google Scholar 

  22. Guo JH, Chen MQ, Chen C, Lu HJ, Xu BH (2015) Efficacy and toxicity of nimotuzumab combined with radiotherapy in elderly patients with esophageal squamous cell carcinoma. Mol Clin Oncol 3(5):1135–1138. https://doi.org/10.3892/mco.2015.606

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Jia J, Cui Y, Lu M, Wang X, Li J, Li J, Li Y, Zhang X, Gao J, Zhou J, Lu Z, Gong J, Yu J, Sun Z, Liu C, Shen L, Zhang X (2016) The relation of EGFR expression by immunohistochemical staining and clinical response of combination treatment of nimotuzumab and chemotherapy in esophageal squamous cell carcinoma. Clin Transl Oncol 18(6):592–598. https://doi.org/10.1007/s12094-015-1406-8

    Article  CAS  PubMed  Google Scholar 

  24. Lu M, Wang X, Shen L, Jia J, Gong J, Li J, Li J, Li Y, Zhang X, Lu Z, Zhou J, Zhang X (2016) Nimotuzumab plus paclitaxel and cisplatin as the first line treatment for advanced esophageal squamous cell cancer: a single centre prospective phase II trial. Cancer Sci 107(4):486–490. https://doi.org/10.1111/cas.12894

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Tomasello G, Petrelli F, Ghidini M, Pezzica E, Passalacqua R, Steccanella F, Turati L, Sgroi G, Barni S (2017) Tumor regression grade and survival after neoadjuvant treatment in gastro-esophageal cancer: a meta-analysis of 17 published studies. Eur J Surg Oncol 43(9):1607–1616. https://doi.org/10.1016/j.ejso.2017.03.001

    Article  CAS  PubMed  Google Scholar 

  26. Li J, Yan H (2018) Skin toxicity with anti-EGFR monoclonal antibody in cancer patients: a meta-analysis of 65 randomized controlled trials. Cancer Chemother Pharmacol. https://doi.org/10.1007/s00280-018-3644-2

    Article  PubMed  PubMed Central  Google Scholar 

  27. Kainis I, Syrigos N, Kopitopoulou A, Gkiozos I, Filiou E, Nikolaou V, Papadavid E (2018) Erlotinib-associated rash in advanced non-small cell lung cancer: relation to clinicopathological characteristics, treatment response, and survival. Oncol Res 26(1):59–69. https://doi.org/10.3727/096504017X14913452320194

    Article  PubMed  Google Scholar 

  28. Steffens M, Paul T, Hichert V, Scholl C, von Mallek D, Stelzer C, Sorgel F, Reiser B, Schumann C, Rudiger S, Boeck S, Heinemann V, Kachele V, Seufferlein T, Stingl J (2016) Dosing to rash?—the role of erlotinib metabolic ratio from patient serum in the search of predictive biomarkers for EGFR inhibitor-mediated skin rash. Eur J Cancer 55:131–139. https://doi.org/10.1016/j.ejca.2015.11.022

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ya Mao.

Ethics declarations

Conflict of interest

The author(s) declare that they have no competing interests.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Qi, S., Mao, Y. & Jiang, M. A phase I study evaluating combined nimotuzumab and neoadjuvant chemoradiotherapy followed by surgery in locally advanced esophageal cancer. Cancer Chemother Pharmacol 84, 1115–1123 (2019). https://doi.org/10.1007/s00280-019-03944-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00280-019-03944-w

Keywords

Navigation