Esophageal Cancer

Docetaxel (Taxotere) has been successfully investigated in the therapy for advanced gastroesophageal tumors as both a single agent and in combination regimens. As a single agent, phase II study results demonstrate an overall response rate of 17% to 24%, with occasional complete responses in a disease in which complete responses are rare. These figures classify docetaxel among the most active agents for the disease.

Combined-modality approaches for the treatment of non-small-cell lung cancer (NSCLC), head and neck cancer, and esophageal cancer offer survival benefits by improving locoregional control and treating micrometastatic disease. The taxanes are active, tolerable drugs in these solid tumors and have radiation-sensitizing activity.

The limited effectiveness of currently available chemotherapy in the treatment of advanced esophageal cancer, and the poor survival achieved in locally advanced disease with combined chemoradiotherapy with or without surgery, have prompted the evaluation of new agents. Irinotecan (CPT-11, Camptosar) has promising single-agent activity in gastrointestinal cancers.

We conducted a phase II study to assess the response rate and toxicity profile of the irinotecan (CPT-11, Camptosar) plus cisplatin combination administered weekly to patients with at least one previous chemotherapy for advanced adenocarcinoma of the stomach or gastroesophageal junction. Patients with histologic proof of adenocarcinoma of the stomach or gastroesophageal junction with adequate liver, kidney, and bone marrow functions were treated with 50 mg/m² of irinotecan plus 30 mg/m² of cisplatin, both administered intravenously 1 day a week for 4 consecutive weeks, followed by a 2-week recovery period.

SAN DIEGO-A new rapid technique for quantitative reverse transcription-polymerase chain reaction (QRT-PCR) detects nodal micrometastases in esophageal cancer patients intraoperatively and predicts disease recurrence. The technique is quicker and perhaps more accurate than intraoperative histology, making it useful in determining the need for neoadjuvant therapy in some types of cancer.

A 65-year-old man with a history of a "bleeding ulcer" 7 years earlier presents with complaints of progressive dysphagia for solids and liquids over the past 4 months. The patient states that he has had a 40-pound weight loss during this time, but denies any fevers, chills, abdominal pain, melena, or anorexia. He states that recently he cannot go to his favorite restaurant, as whenever he eats he experiences severe coughing fits. He also describes regurgitation of undigested materials soon after eating.

A 60-year-old attorney presents with chronic heartburn and regurgitation. His symptoms have steadily increased over the last 2 years, and he is currently using daily therapy with a proton pump inhibitor. There is no history of gastrointestinal bleeding, dysphagia, or weight loss.

WASHINGTON-Combining gene therapy with radiotherapy may provide a useful approach to combating human esophageal cancers, said Vinay Kumar Gupta, MD, of the University of Chicago Medical School, at the 54th Annual Cancer Symposium of the Society of Surgical Oncology.

WASHINGTON-Sufficient evidence exists to suggest that patients undergoing pancreatic and esophageal cancer surgery have lower mortality rates at high-volume hospitals and that physicians and patients should consider this fact in making treatment decisions, a report by the Institute of Medicine (IOM) said.

The Food and Drug Administration (FDA) and the National Cancer Institute (NCI) inaugurated a new program in July that

SAN FRANCISCO-Two cycles of preoperative cisplatin (Platinol) and fluorouracil (5-FU) may improve survival in patients with resectable esophageal cancer, compared with surgery alone, according to a large study from the United Kingdom presented at the 37th Annual Meeting of the American Society of Clinical Oncology (ASCO abstract 502).

NEW YORK-Esophageal cancer, though relatively rare in the United States, is deadly, with a 90% mortality for patients treated with conventional therapy. David H. Ilson, MD, PhD, assistant attending physician at Memorial Sloan-Kettering Cancer Center in New York City, described new multimodal attempts to improve these outcomes.

SAN ANTONIO, Texas-Although combined-modality therapy is considered the standard of care for patients with advanced esophageal cancer, the anatomical and physiological characteristics of the esophagus pose serious limitations on dose escalation. Cytoprotective strategies that might allow clinicians to circumvent these limitations were reviewed by Charles R. Thomas. Jr., MD.

WASHINGTON-Medicare will begin or expand coverage of positron emission tomography (PET) diagnostic scans for several cancers on July 1. For the first time, Medicare will cover PET for head and neck cancers, except for central nervous system and thyroid cancers, and esophageal cancer. Coverage will apply to diagnosis, staging, and restaging.

Irinotecan (Camptosar) has shown activity in several solid tumor malignancies, including gastric and pancreatic cancer. In vitro studies suggest antitumor activity in esophageal cancer cell lines. Sequence-dependent synergy

PHILADELPHIA-Physicians should approach the use of retinoids for chemoprevention of aerodigestive cancers very carefully, warns a research scientist who has been studying the use of natural and synthetic vitamin A in animal models with esophageal cancer. The studies have shown increased tumorigenicity among the animals treated with the synthetic vitamin.

HAMBURG, Germany-Barely one fifth of patients who undergo surgery for esophageal cancer are alive 2 years later, and studies exploring the possible benefits of preoperative chemotherapy and radiotherapy have yielded equivocal results at best.

Chemotherapy for advanced gastric and gastroesophageal junction carcinomas remains suboptimal. Both irinotecan (Camptosar) and cisplatin (Platinol) are active against this group of malignancies. This article focuses

SAN DIEGO-Although there are some families that have a high prevalence of Barrett’s esophagus, the disease is more frequently sporadic, Yvonne Romero, MD, of the Mayo Clinic, reported at the annual meeting of the American Gastroenterological Association, held during the Digestive Disease Week conference. She and her colleagues studied symptomatic relatives of Barrett’s esophagus patients to determine if family relationships could help predict the disease.

PHOENIX-A more aggressive endoscopic biopsy protocol detected more early cancers in Barrett’s esophageal tissue than the standard protocol. Moreover, two separate studies have begun to identify specific genetic markers that may allow physicians to stratify patients with Barrett’s esophagus according to their risk for cancer progression.

Esophageal cancer poses an interesting challenge for oncologists. Esophageal squamous cell cancer has the most varied geographical incidence of any cancer, suggesting the existence of critically important environmental and molecular epidemiologic factors. These factors remain largely unrecognized.

Esophageal cancer is a relatively rare but deadly cancer in the United States. Even in patients with limited locoregional disease at the time of diagnosis, who have received aggressive multimodality therapies as part of clinical protocols, median survival is only 17 months and 3-year survival, only 30%.[1,2] Patients with metastatic disease have a 6-month median survival, which is not improved by the administration of chemotherapy.

Esophageal cancer, with an estimated number of 12,300 new cases in the year 2000, is relatively uncommon in the United States but produces a high number of annual deaths, estimated at 12,100. Moreover, the incidence of the

Dr. Minsky’s two-part review of primary and adjuvant treatment of esophageal cancer is current and comprehensive. In it, he details our present understanding of esophageal cancer management by reviewing the most important studies conducted over the past 2 decades.

Dr. Minsky provides an excellent review of the current status of primary and adjuvant therapy in patients with carcinoma of the esophagus. Although the treatment of esophageal cancer remains a hotly debated issue, recent results clearly show the superiority of combined-modality therapy, especially when surgical resection is not planned.

The two general treatment approaches for esophagel cancer are primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Due to differences in the patient populations selected for surgical or nonsurgical therapies, which may bias the results against nonsurgical therapy, it is difficult to determine the best treatment approach for this disease. The standard of care is either surgery alone or primary combined-modality therapy. Based on a nonrandomized comparison of the data from recent intergroup trials, the results of these two approaches are similar. For patients treated without surgery, the intergroup INT 0123 trial will determine whether higher doses of radiation are of benefit. No clear survival advantage has been seen with preoperative or postoperative adjuvant radiation therapy alone or chemotherapy alone. The randomized trials comparing preoperative combined-modality therapy vs surgery alone reveal encouraging results for the combination approach but need further confirmation. For patients treated with combined-modality therapy, the ideal regimen remains to be determined. Part 1 of this two-part review, which appeared in last month’s issue, centered on primary therapy for esophageal carcinoma. This part explores the rationale for and results of adjuvant therapy. [ONCOLOGY 13(10):1415-1427,1999]

The two general treatment approaches for esophagel cancer include primary treatment (surgical or nonsurgical) or adjuvant treatment (preoperative or postoperative). Due to differences in the patient populations selected for

Photodynamic therapy (PDT) relieves swallowing problems associated with esophageal cancer in the majority of patients treated, according to a study conducted from November 1996 to June 1998 at the University of Pittsburgh Cancer Institute.

For patients with high-grade dysplasia associated with Barrett’s esophagus or adenocarcinoma, photodynamic therapy

NEW YORK-Preliminary data presented at the Chemotherapy Foundation Symposium XVI suggest that the toposiomerase I inhibitor irinotecan (Camptosar) in combination with other chemotherapy agents may be effective in multiple tumor types, including advanced non-small-cell lung cancer (NSCLC) and advanced esophageal cancer.