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Developments in Treatment of Esophageal/Gastric Cancer

  • Esophageal/Gastric Small and Large Bowel/Anal Cancer
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Advances have been achieved in the therapy of esophageal and gastric cancer (including carcinoma of gastroesophageal junction); however, it poses a continuous challenge to treat this highly virulent disease effectively. The concept of the benefits of perioperative (pre- or/and post-) therapy (chemotherapy or chemoradiation) has been accepted and confirmed by several large randomized phase III studies globally in different regions, settings, and patient population (INT 0116, MAGIC, ACTS-GC, and JCOG 9907). Efficacy of combination of newer cytotoxic chemotherapy agents has been demonstrated with increased progression-free survival and overall survival in patients with metastatic disease (e.g., REAL-2, V325, SPIRITS, and COG9912). Encouraging results have been shown from recent preliminary data with biological and target-oriented agents in the treatment of esophageal and gastric cancer.

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References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jemal A, Siegel R, Ward E, et al. Cancer Statistics, 2008. CA Cancer J Clin. 2008; 58:71-96. doi:10.3322/CA.2007.0010.

    Article  PubMed  Google Scholar 

  2. Blot WJ, McLaughlin JK. The changing epidemiology of esophageal cancer. Semin Oncol. 1999; 26 (5 Suppl 15):2-8.

    PubMed  CAS  Google Scholar 

  3. Bytzer P, Christensen PB, Damkier P, et al. Adenocarcinoma of the esophagus and Barrett’s esophagus: a population-based study. Am J Gastroenterol. 1999; 94: 86-91 doi:10.1111/j.1572-0241.1999.00776.x.

    Article  PubMed  CAS  Google Scholar 

  4. Parkin DM, Bray F, Ferlay J, et al. Global cancer statistics 2002. CA Cancer J Clin. 2005; 55:74-108. doi:10.3322/canjclin.55.2.74.

    Article  PubMed  Google Scholar 

  5. Ries LAG, Eisner MP, Kosary CL, et al., eds: SEER Cancer Statistics Review, 1975–2002, National Cancer Institute, Bethesda, MD, http://seer.cancer.gov/csr/1975-2002/, based on Novembers 2004 SEER data submission, posted to the SEER web site 2005

  6. Macdonald JS, Smalley SR, Benedetti J, et al. Chemoradiotherapy after surgery compared with surgery alone for adenocarcinoma of the stomach or gastroesophageal junction. N Engl J Med. 2001; 345:725-730. doi:10.1056/NEJMoa010187.

    Article  PubMed  CAS  Google Scholar 

  7. Macdonald JS, Smalley SR, Benedetti J, et al: Postoperative combined radiation and chemotherapy improves disease-free survival and overall survival in resected adenocarcinoma of the stomach and gastroesophageal junction: updated of the results of Intergroup Study INT-0116. Proc GI Can Symp 2004, 1:abstract 6

  8. Cunningham D, Allum WH, Stenning SP, et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Engl J Med. 2006;355:11-20. doi:10.1056/NEJMoa055531.

    Article  PubMed  CAS  Google Scholar 

  9. Sasako M, Yamaguchi T, Kinoshita T, et al: Randomized phase III trial comparing S-1 monotherapy versus surgery alone for stage II/III gastric cancer patients (pts) after curative D2 gastrectomy (ACTS-GC study). 2007 Gastrointestinal Cancer Symposium, Orlando, abstract no. 8

  10. 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)—Radiation Therapy Oncology Group. JAMA. 1999; 281:1623-1627. doi:10.1001/jama.281.17.1623.

    Article  PubMed  CAS  Google Scholar 

  11. Kelson DP, Wniter KA, Gunderson LL, et al. Long-term results of RTOG trial 8911 (USA intergroup 113): A random assignment trial comparison of chemotherapy followed by surgery compared with surgery alone for esophageal cancer. J Clin Oncol. 2007; 25: 3719-3725. doi:10.1200/JCO.2006.10.4760.

    Article  Google Scholar 

  12. Medical Research Council Oesophageal Cancer Working Group. Surgical resection with or without preoperative chemotherapy in oesophageal cancer: a randomized controlled trial. Lancet. 2002; 359:1727-1733 doi:10.1016/S0140-6736(02)08651-8.

    Article  Google Scholar 

  13. Allum WH, Fogarty PJ, Stenning SP, et al.: Long term results of the MRC OEO2 randomized trial of surgery with or without preoperative chemotherapy in resectable esophageal cancer. Proc GI Can Symp 2008, 1:abstract 9

  14. Ando N, Kato H, Shioda M, et al.: A randomized trial of postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus neoadjuvant chemotherapy for localized squamous cell carcinoma of the thoracic esophagus (JCOG 9907). Proc GI Can Symp 2008, 1:abstract 10

  15. Tepper J, Krasna MJ, Niedzwiecki D, et al. Phase III trial of trimodality therapy with cisplatin, fluorouracil, radiotherapy, and surgery compared with surgery alone for esophageal cancer: CALGB 9781. J Clin Oncol. 2008; 26:1086-1092. doi:10.1200/JCO.2007.12.9593.

    Article  PubMed  CAS  Google Scholar 

  16. Walsh TN, Noonan N, Hollywood D, et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Engl J Med. 1996;335:462-7. doi:10.1056/NEJM199608153350702.

    Article  PubMed  CAS  Google Scholar 

  17. Burmeister BH, Smithers BM, Gebski V, et al. Surgery alone versus chemoradiotherapy followed by surgery for resectable cancer of the oesophagus: a randomised controlled phase III trial. Lancet Oncol. 2005; 6:659-68. doi:10.1016/S1470-2045(05)70402-2.

    Article  PubMed  Google Scholar 

  18. Stahl M, Stuschke M, Lehmann N, et al. Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus. J Clin Oncol. 2005;23:2310-7 doi:10.1200/JCO.2005.00.034.

    Article  PubMed  Google Scholar 

  19. Bedenne L, Michel P, Bouché O, et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin Oncol. 2007;25:1160-8. doi:10.1200/JCO.2005.04.7118.

    Article  PubMed  CAS  Google Scholar 

  20. Ilson DH, Saltz L, Enzinger P, et al. Phase II trial of gemcitabine, 5-fluorouracil and leucovorin in advanced esophageal carcinoma. Oncology. 2005; 69: 130. doi:10.1159/000087815.

    Article  CAS  Google Scholar 

  21. Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase III study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: a report of the V325 Study Group. J Clin Oncol. 2006; 24:4991-4997 doi:10.1200/JCO.2006.06.8429.

    Article  PubMed  CAS  Google Scholar 

  22. Cunningham D, Starling N, Rao S, et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Engl J Med. 2008; 358:36-46. doi:10.1056/NEJMoa073149.

    Article  PubMed  CAS  Google Scholar 

  23. Al-Batran SE, Hartmann JT, Probst S, et al. Phase III trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: a study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol. 2008; 26:1435-1442. doi:10.1200/JCO.2007.13.9378.

    Article  PubMed  CAS  Google Scholar 

  24. N. Boku, S. Yamamoto, K. Shirao, Randomized phase III study of 5-fluorouracil (5-FU) alone versus combination of irinotecan and cisplatin (CP) versus S-1 alone in advanced gastric cancer (JCOG9912) J Clin Oncol 2007; 25:18S, LBA4513.

    Google Scholar 

  25. Koizumi W, Narahara H, Hara T, et al.: S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol. 2008;9:215-21. doi:10.1016/S1470-2045(08)70035-4.

    Article  PubMed  CAS  Google Scholar 

  26. Ajani JA, Rodriguez W, Bodoky G, et al: Multicenter phase III comparison of cisplatin/S-1 (CS) with cisplatin/5-FU (CF) as first-line therapy in patients with advanced gastric cancer (FLAGS). Gastrointestional Cancers Symposium 2009, abstract 8

  27. Yan TD, Black D, Sugarbaker PH, et al. A systematic review and meta-analysis of the randomized controlled trials on adjuvant intraperitoneal chemotherapy for resectable gastric cancer. Ann Surg Oncol. 2007;14:2702-2713.

    Article  PubMed  Google Scholar 

  28. Kang Y, Chang H, Zang D, et al.: Postoperative adjuvant chemotherapy for grossly serosa-positive advanced gastric cancer: a randomized phase III trial of intraperitoneal cisplatin and early mitomycin-C plus long-term doxifluridine plus cisplatin (iceMFP) versus mitomycin-C plus short- term doxifluridine (Mf) (AMC 0101) (NCT00296322). J Clin Oncol 2008, 26(May 20 suppl; abstr LBA4511)

  29. Kang Y, Chang H, Min Y, et al.: A randomized phase III trial comparing mitomycin-C plus short-term doxifluridine (Mf) versus mitomycin-C plus long-term doxifluridine plus cisplatin (MFP) after curative resection of advanced gastric cancer (AMC 0201). Proc ASCO GI Can Symp 2008, 1:abstract 6

  30. Tew WP, Shah M, Schwartz G, et al.: Phase II trial of erlotinib for second-line treatment in advanced esophageal cancer. Proc ASCO GI Can Symp 2005, 85:abstract 5

  31. Shah A, Ramanathan RK, Ilson D, et al.: Final results of a multicenter phase II study of irinotecn (CPT), cisplatin (CIS) and bevacizumab (BEV) in patients with metastatic gastric or gastroesophageal (GEJ) adenocarcinoma (NCI#6647). J Clin Oncol 2006, 24(N18)4020

  32. Suntharalingam M, Dipetrillo T, Akerman P, et al.: Cetuximab, paclitaxel,carboplatin and radiation for esophageal and gastric cancer. J Cancer Oncol 24, 18S(4029)

    Google Scholar 

  33. Yoshikawa R, Koishi K, et al.: Recurrence patterns and prognosis of esophageal cancer patients with persistent expression of chemokine receptor CXCR3 after neoadjuvant chemoradiotherapy. Proc GI Can Symp 2008, 1:abstract 98

  34. Blanchard P, Quero L, Schlageter MH, et al.: Prognostic value of anti-p53 (p53 abs) and anti-Kiras (KiRas abs) circulating antibodies in esophageal carcinomas treated with chemoradiotherapy (CT-RT). Proc GI Can Symp 2008, 1:abstract 24

  35. Safran H, Suntharalingam M, Dipetrillo T, Cetuximab with concurrent chemoradiation for esophagogastric cancer: assessment of toxicity. Int J Radiat Oncol Biol Phys. 2008;70:391-395. doi:10.1016/j.ijrobp.2007.07.2325.

    PubMed  CAS  Google Scholar 

  36. Pinto C, Di Fabio F, Siena S, et al. Phase II study of cetuximab in combination with FOLFIRI in patients with untreated advanced gastric or gastroesophageal junction adenocarcinoma (FOLCETUX study). Ann Oncol. 2007; 18(3):510-517. doi:10.1093/annonc/mdl459.

    Article  PubMed  CAS  Google Scholar 

  37. Han S, Park S, Lee K, et al.: Phase II study and biomarker analysis of cetuximab in combination with oxaliplatin, 5-fluorouracil, and leucovorin as first-line treatment in patients with recurrent or metastatic gastric cancer. J Clin Oncol 2008, 26:abstract 4549

  38. Gold PJ, Goldman B, Iqbal S, et al.: Cetuximab as second-line therapy in patients with metastatic esophageal cancer: a phase II Southwest Oncology Group study. Proc GI Can Symp 2008, 1:abstract 96

  39. DragovichT, McCoy S, Fenoglio-Preiser CM, Phase II trial of erlotinib in gastroesophageal junction and gastric adenocarcinomas: SWOG 0127. J Clin Oncol. 2006 Oct 20;24(30):4922-7. doi:10.1200/JCO.2006.07.1316.

    Article  PubMed  CAS  Google Scholar 

  40. Shah MA, Ramanathan RK, Ilson DH, et al. Multicenter phase II study of irinotecan, cisplatin, and bevacizumab in patients with metastatic gastric or gastroesophageal junction adenocarcinoma. J Clin Oncol. 2006;24:5201-5206. doi:10.1200/JCO.2006.08.0887.

    Article  PubMed  CAS  Google Scholar 

  41. Enzinger PC, Ryan DP, Regan EM, et al.: Phase II trial of docetaxel, cisplatin, irinotecan, and bevacizumab in metastatic esophagogastric cancer. Proc GI Can Symp 2008, 1:abstract 97

  42. Bang Y, Kang Y, Kang Y, et al.: Sunitinib as second-line treatment for advanced gastric cancer: preliminary results from a phase II study. Proc Am Soc Clin Oncol, abstract 4603

  43. Sun W, Powell M, O’Dwyer P, et al.: A phase II study: combination of sorafenib with docetaxel and cisplatin in the treatment of metastatic or advanced unresectable gastric and gastroesophageal junction (GEJ) adenocarcinoma (ECOG 5203). J Clin Oncol 2008, 26:abstract 4535

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Correspondence to Weijing Sun MD.

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Liu, W., Zhang, X. & Sun, W. Developments in Treatment of Esophageal/Gastric Cancer. Curr. Treat. Options in Oncol. 9, 375–387 (2008). https://doi.org/10.1007/s11864-009-0097-1

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