Clinical outcomes following neoadjuvant nab-paclitaxel and cisplatin chemothera
PUBLISHED: 2015-11-27  199 total views, 1 today

Weimin Mao1  Yun Fan2  Youhua Jiang1  Xinming Zhou1  Qixun Chen1Zhiyu Huang2  Lei Gong2  Haifeng Yu2  Haiyan Yang2  Jinshi Liu1, Pengcheng Chen1  Qiang Zhao1

1HangZhou Zhejiang CancerHospitalthoracic tumor department

2HangZhou Zhejiang CancerHospital chemotherapy department

Objective: Thecombination of nab-paclitaxel and cisplatin as preoperative treatment foresophageal squamous cell carcinoma (ESCC) has not been investigated. We carriedout a phase II feasibility and efficiency study of preoperative chemotherapywith nab-paclitaxel and cisplatin for locally advanced ESCC. Method: BetweenJanuary 2011 and October 2012,35patients,from stage ⅡAto ⅢC,performancestatus 0-1,with 31 male and 4 females,wereincluded in the study. All pts received nab-paclitaxel (100mg/m2, d1,d8, d22 and d29) and cisplatin (75mg/m2, d1 and d22) as neoadjuvant chemotherapy,followed by esophagectomy. Two cycles of adjuvant chemotherapy with sameregimen was given in 4-6 weeks after the resection. Result: Overallresponse rate (ORR) evaluation was performed at the end of cycle 2. Out of the35 enrolled patients, 30 were malesand 4 females; Three (8.6%), 5(14.3%), 10(28.6%), 8 (22.9%) and 9 (25.7%) patients were in ⅡA,ⅡB,ⅢA,ⅢB,ⅢC,respectively. 5 patients did not going to surgery, as 2 patients withprogressive disease and another 3 patients refused. 30/35 patients wenttosurgery (85.7%) and all had R0 resection (100%). Pathological completeresponse (pCR) was achieved in 4 patients (13.3%). Near pCR (microfoci of tumorcells onthe primary tumor without lymph nodal metastases) in 2 patients (6.7%).Down-staging was observed in 19 of 30 patients (63.3%). 24/30 (80.0%) patients receivedadjuvant chemotherapy; among, 7 patients (23.3%) received adjuvantchemoradiotherapy. Only 1 (3.3%) patient appeared surgical complication with anastomoticleaks. The most frequent G3-G4 toxicity included neutropenia (11.4%), anemia(8.6%), thrombocytopenia (5.7%), nausea/vomiting (14.3%), neutropenia fever(8.6%), asthenia (20.0%). With median follow up of 27.1months,the16/30 patients(50.4%) still alive, and a median disease-free times(DFS) of22.5months (95% CI 14.2-29.8) were observed. Median overall survival times andDFS of down-staging patients were significantly longer than non-down-stagingpatients (Hazard Ratio 0.30, 95% CI: 0.074- 0.75 and Hazard Ratio 0.27, 95% CI:0.071-0.59, respectively) (P=0.0158 and P=0.0037, respectively). Conclusion:Weekly nab-paclitaxel and cisplatin is effective as a neoadjuvantchemotherapy for local advanced ESCC, and its adverse effects are tolerable, down-stagingpatients have favorable outcome than non-down-staging patients.

Key Words: nabpaclitaxel  neoadjuvant chemotherapy  esophageal

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