Oesophagus Cancer

Question 1

Preoperative Chemoradiation

Answer 1

Infusional fluorouracil can be replaced with capecitabine

• Preferred Regimens:
Paclitaxel and carboplatin (category 1)
Fluorouracil and cisplatin (category 1)
Fluorouracil and oxaliplatin (category 1)

• Other Regimens:
Irinotecan and cisplatin (category 2B)
Paclitaxel and fluoropyrimidine (fluorouracil or capecitabine) (category 2B)

Question 2

Perioperative Chemotherapy
(Only for adenocarcinoma of the thoracic esophagus or EGJ)
(3 cycles preoperative and 3 cycle postoperative)

Answer 2

• Fluorouracil and cisplatin (category 1)
• ECF (epirubicin, cisplatin, and fluorouracil) (category 3)
• ECF modifications (category 3 for all modifications)
Epirubicin, oxaliplatin, and fluorouracil
Epirubicin, cisplatin, and capecitabine
Epirubicin, oxaliplatin, and capecitabine

Question 3

Preoperative chemotherapy (2 cycles) 
(Only for adenocarcinoma of the thoracic esophagus or EGJ)

Answer 3

• Fluorouracil and cisplatin (category 2B)

Question 4

Definitive Chemoradiation

Infusional fluorouracil can be replaced with capecitabine

Answer 4

• Preferred Regimens:
Fluorouracil and cisplatin (category 1)
Fluorouracil and oxaliplatin (category 1)
Paclitaxel and carboplatin1

•Other Regimens:
Cisplatin with docetaxel or paclitaxel
Irinotecan and cisplatin (category 2B)
Paclitaxel and fluoropyrimidine (fluorouracil or capecitabine) (category 2B)

Question 5

Postoperative Chemoradiation

Answer 5

• Fluoropyrimidine (infusional fluorouracil or capecitabine) before and after fluoropyrimidine-based chemoradiation

Question 6

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)

Answer 6

• Trastuzumab should be added to first-line chemotherapy for HER2-neu overexpressing metastatic adenocarcinoma
Combination with fluoropyrimidine and cisplatin (category 1)
Combination with other chemotherapy agents (category 2B)
Trastuzumab is not recommended for use with anthracyclines

Question 7

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)
First-Line Therapy

Answer 7

Two-drug cytotoxic regimens are preferred because of lower toxicity.
Three-drug cytoxic regimens should be reserved for medically fit patients with good PS and access to frequent toxicity evaluation.

• Preferred Regimens:
Fluoropyrimidine (fluorouracil or capecitabine) and cisplatin (category 1)
Fluoropyrimidine (fluorouracil or capecitabine) and oxaliplatin

DCF modifications
◊ Docetaxel, cisplatin, and fluorouracil
◊ Docetaxel, oxaliplatin, and fluorouracil
◊ Docetaxel, carboplatin, and fluorouracil (category 2B)

• Other Regimens:
Paclitaxel with cisplatin or carboplatin
Docetaxel with cisplatin
Fluoropyrimidine(fluorouracil or capecitabine) Docetaxel
Paclitaxel
Fluorouracil and irinotecan (category 1)
ECF (epirubicin, cisplatin, and fluorouracil) (category 1)
ECF modifications (category 1)
◊ Epirubicin, oxaliplatin, and fluorouracil
◊ Epirubicin, cisplatin, and capecitabine
◊ Epirubicin, oxaliplatin, and capecitabine

Question 8

Systemic Therapy for Unresectable Locally Advanced, Recurrent or Metastatic Disease (where local therapy is not indicated)
Dependent on prior therapy and PS:
Second-Line Therapy

Answer 8

• Preferred Regimens: 
Ramucirumab and paclitaxel for adenoca
(category 1 for EGJ adenocarcinoma; category 2A for esophageal adenocarcinoma)
Docetaxel (category 1)
Paclitaxel (category 1)
Irinotecan (category 1)
Ramucirumab for adenocarcinoma 
(category 1 for EGJ adenocarcinoma; category 2A for esophageal adenocarcinoma) 

• Other Regimens:
Irinotecan and cisplatin
Fluoropyrimidine (fluorouracil or capecitabine) and irinotecan (category 2B)
Docetaxel and irinotecan(category 2B)