Chemotherapeutic options for gastroesophageal junction tumors

Semin Radiat Oncol. 2013 Jan;23(1):24-30. doi: 10.1016/j.semradonc.2012.09.003.

Abstract

A doublet of a fluoropyrimidine and a platinum compound remains the reference regimen in palliative chemotherapy for esophagogastric cancers. Newer regimens involve the substitution of infusional 5-fluorouracil (FU) for a shorter infusional schedule or oral 5-FU prodrugs and the replacement of cisplatin with oxaliplatin. Although the addition of epirubicin to the standard 2-drug regimen is part of routine practice, there are no randomized data to support a benefit. In contrast, the docetaxel-based docetaxel/cisplatin/5-FU regimen has been shown to modestly improve survival compared with 5-FU/cisplatin alone but at the expense of significant additional toxicity, which has hindered widespread acceptance of this regimen. Irinotecan-containing regimens have also been evaluated in a few phase III evaluations but are not clearly superior to 5-FU/cisplatin or even infusional 5-FU alone. Nevertheless, their favorable toxicity profile indicates that infusional 5-FU/irinotecan regimens also represent a first-line therapy option. In addition to its primary role in palliative therapy, there are also now established peri- or postoperative chemotherapy strategies that increase survival rates by approximately 10-15% compared with surgery alone. Preoperative chemoradiation in esophageal and gastroesophageal junction tumors has also been shown to improve outcomes.

Publication types

  • Review

MeSH terms

  • Anthracyclines / therapeutic use
  • Antineoplastic Agents / therapeutic use
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Bridged-Ring Compounds / therapeutic use
  • Camptothecin / analogs & derivatives
  • Camptothecin / therapeutic use
  • Esophageal Neoplasms / drug therapy*
  • Esophagogastric Junction / drug effects*
  • Humans
  • Irinotecan
  • Palliative Care / methods
  • Stomach Neoplasms / drug therapy*
  • Taxoids / therapeutic use

Substances

  • Anthracyclines
  • Antineoplastic Agents
  • Bridged-Ring Compounds
  • Taxoids
  • taxane
  • Irinotecan
  • Camptothecin