Two-, three-course neoadjuvant chemo equally feasible in locally advanced ESCC

The two- and three-course DCF (docetaxel, cisplatin, and fluorouracil) regimens are both useful in the neoadjuvant treatment of locally advanced oesophageal squamous cell cancer (ESCC), with additional courses yielding better response without the increased risk of adverse events or postoperative morbidity, according to the results of a phase II trial.

A total of 90 patients with locally advanced ESCC were randomized to undergo either two (n=91) or three (n=89) courses of DCF (70 mg/m² intravenous docetaxel and 70 mg/m² intravenous cisplatin on day 1, and a continuous 700 mg/m² fluorouracil infusion for 5 days) every 3 weeks, followed by surgery.

Completion rates were comparable between the two- and three-course regimens, as were overall neoadjuvant chemotherapy dose reductions.

Although grades 3–4 leukopoenia and anaemia occurred with less frequency in the two-course group, the overall toxicity rates were similar as compared with the three-course group.

Postoperative complications were likewise similar in the two groups, except arrhythmia, which occurred in 13 percent of patients in the two-course group vs none in the three-course group (p=0.0007). There were two cases of postoperative in-hospital deaths recorded in the three-course group, due to sepsis following severe pneumonia.

Finally, the three- vs the two-course regimen was associated a significantly better clinical response (42.9 percent vs 65.2 percent; p=0.0027) and a relatively higher rate of pathological complete response (9.1 percent vs 15.3 percent; p=0.212).