The benefit of taxane-based therapies over fluoropyrimidine plus platinum (FP) in the treatment of esophageal cancer: a meta-analysis of clinical studies.

Abstract

PURPOSE:

Fluoropyrimidine plus platinum (FP) is currently the standard treatment for esophageal cancer (EC). In recent years, taxane-based chemotherapy has also been used and has shown good efficacy in EC. This study aims to investigate the advantages of taxane-based over FP chemotherapy, as well as discuss its drawbacks, in the treatment of EC.

PATIENTS AND METHODS:

A literature search was done for studies comparing clinical outcomes between taxane-based and FP chemotherapy in EC. Pooled analyses were performed to compare the efficacy and grade 3/4 adverse events in patients who received neoadjuvant chemotherapy (NACT), neoadjuvant chemoradiotherapy (NACRT), or definitive chemoradiotherapy (dCRT). Subgroup analyses were also conducted in esophageal squamous cell carcinoma (ESCC).

RESULTS:

Thirty-one studies with a total of 3,912 patients were included in the analysis. Better long-term survival was found in patients who received taxane-based NACT (progression-free survival (PFS): pooled HR=0.58, P=0.0008; and overall survival (OS): pooled HR=0.50, P<0.00001) and dCRT (PFS: pooled HR=0.75, P<0.0001). In NACRT, taxane-based treatment and FP showed similar efficacy. In ESCC patients, taxane-based treatment showed better OS (NACT: pooled HR=0.57, P=0.02; NACRT: pooled HR=0.51, P=0.03; and dCRT: pooled HR=0.73, P<0.0001) than FP chemotherapy. Furthermore, taxane-based therapy also showed a better short-term response (complete response (CR), objective response rate (ORR), disease control rate (DCR), or pathologic complete response (pCR). However, taxane-based therapy was significantly correlated with a higher incidence of grade 3/4 leukopenia, neutropenia, and diarrhea.

CONCLUSION:

Compared to FP, taxane-based therapy produced better clinical response and outcomes in EC patients receiving NACT or dCRT, and in all types of therapy in patients with ESCC. Taxane-based treatment is associated with more frequent toxicity.

• Authors: Tao Wang, Jie Yu, Min Liu, Yanliang Chen, Caiyun Zhu, Lin Lu, Mingzhu Wang, Lingfeng Min, Xinxin Liu, Xizhi Zhang, Johannes A Gubat, Yong Chen
• Journal: Drug design, development and therapy (Drug Des Devel Ther) Vol. 13 Pg. 539-553 ( 2019) ISSN: 1177-8881 [Electronic] New Zealand
• PMID: 30787595 (Publication Type: Comparative Study, Journal Article, Meta-Analysis)

Chemical References

• Antineoplastic Agents
• Bridged-Ring Compounds
• Organoplatinum Compounds
• Pyrimidines
• Taxoids
• taxane
• 5-fluoropyrimidine

Topics

• Antineoplastic Agents (adverse effects, therapeutic use)
• Bridged-Ring Compounds (adverse effects, therapeutic use)
• Esophageal Neoplasms (drug therapy)
• Humans
• Organoplatinum Compounds (therapeutic use)
• Pyrimidines (therapeutic use)
• Taxoids (adverse effects, therapeutic use)