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Esophagogastric Adenocarcinoma: Is More Chemotherapy Better?

  • Upper Gastrointestinal Cancers (L Rajdev, Section Editor)
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

Two cycles of neoadjuvant cisplatin and fluoropyrimidine (CF) and 6 cycles of perioperative CF with or without epirubicin are an evidence-based approach in operable esophageal and esophagogastric junctional adenocarcinomas. Three-drug regimens with anthracycline or taxane are associated with significantly higher tumor regression rates, with an expected increase in toxicity. In order to achieve an R0 resection and consequently a survival advantage, in selected patients having a risk of a threatened margin or incomplete resection, chemotherapy might be continued beyond 2 cycles if a response has been demonstrated. In metastatic setting, multidrug combination regimens have demonstrated a significant survival benefit when compared to single-agent regimes. A three-drug regimen should be considered for fit patients and/or when a response is required for symptom control. The expected increase in toxicity needs to be carefully considered and discussed with patients. The choice to use a taxane in first-line setting may limit the options of second-line treatment to irinotecan-containing regimens and also precludes the use of anthracyclines in the first line. For this reason, we prefer to reserve taxane-based therapy for the second-line setting.

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  1. The Royal Marsden Hospital NHS Foundation Trust, London, UK

    Elisa Fontana MD, Elizabeth C. Smyth MD & David Cunningham MD

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  1. Elisa Fontana MD
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Elisa Fontana declares that she has no conflict of interest.

Elizabeth C. Smyth declares that she has no conflict of interest.

David Cunningham has received financial support through grants from Amgen, AstraZeneca, Bayer, Celgene, Merck Serono, MedImmune, Merrimack, Novartis, Roche, and Sanofi.

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Fontana, E., Smyth, E.C. & Cunningham, D. Esophagogastric Adenocarcinoma: Is More Chemotherapy Better?. Curr. Treat. Options in Oncol. 17, 21 (2016). https://doi.org/10.1007/s11864-016-0395-3

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