Metronomic weekly paclitaxel in advanced unresectable esophageal cancer.
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Date
2013-04
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Abstract
CONTEXT: Advanced esophageal cancer is aggressive with an expected median survival of 6‑7 months. Combination
chemotherapy regimens provide effective palliation, but result in substantial toxicity. MATERIALS AND METHODS: Retrospective
analysis of prospectively collected data of patients with advanced esophageal cancer, not amenable to definitive intent
therapy who were treated with intravenous weekly paclitaxel. RESULTS: Between October 2010 and August 2011, 51
patients were included. Median age was 56 years, with a male: female ratio of 2.9:1. 29% were mid esophageal and 55%
were lower third and gastroesophageal junction tumors. 65% of the tumors had squamous histology. Performance status was
> 2 in 45%. 61% patients had received prior therapy, either definitive or palliative. 51% patients were platinum‑pre‑treated
and 29% had received prior 3 weekly paclitaxel. 76% patients had distant metastases. Median number of cycles of weekly
paclitaxel delivered was 11. 71% of patients had improvement in dysphagia, with a median time to symptom improvement
of 9 days. In 72% patients, the feeding nasogastric tube could be removed. Overall response rate was 49% (complete
remission: 4%, partial remission: 45%, stable disease: 13%). Median progression free survival was 4.7 months (confidence
interval [95% CI: 3.7‑5.7 months]) and median overall survival was 7.5 months (95% CI: 3.1‑11.8 months). Histopathology,
performance status and pre‑treatment albumin significantly affected survival. The most common grade 3/4 toxicities included
hyponatremia (14%), fatigue (16%), diarrhea (12%), anemia (31%), neutropenia (10%) and febrile neutropenia (4%).
CONCLUSIONS: Metronomic weekly paclitaxel chemotherapy may provide palliative benefit in advanced unresectable
metastatic esophageal cancer with minimal toxicity.
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Keywords
Chemotherapy, esophageal neoplasms, esophagogastric junction, esophagus, metronomic, paclitaxel, palliative
Citation
Noronha V, Patil V, Bhosale B, Joshi A, Purandare N, Prabhash K. Metronomic weekly paclitaxel in advanced unresectable esophageal cancer. Indian Journal of Cancer. 2013 Apr-June; 50(2): 128-134.