title: Esophagogastric Adenocarcinoma: Is More Chemotherapy Better?
abstract: Two cycles of neoadjuvant cisplatin and fluoropyrimidine (CF) and 6 cycles of perioperative CF with or without epirubicin are an evidence-based approach in operable esophageal and esophagogastric junctional adenocarcinomas. Three-drug regimens with anthracycline or taxane are associated with significantly higher tumor regression rates, with an expected increase in toxicity. In order to achieve an R0 resection and consequently a survival advantage, in selected patients having a risk of a threatened margin or incomplete resection, chemotherapy might be continued beyond 2 cycles if a response has been demonstrated. In metastatic setting, multidrug combination regimens have demonstrated a significant survival benefit when compared to single-agent regimes. A three-drug regimen should be considered for fit patients and/or when a response is required for symptom control. The expected increase in toxicity needs to be carefully considered and discussed with patients. The choice to use a taxane in first-line setting may limit the options of second-line treatment to irinotecan-containing regimens and also precludes the use of anthracyclines in the first line. For this reason, we prefer to reserve taxane-based therapy for the second-line setting.
authors.affiliation: The Royal Marsden Hospital NHS Foundation Trust, London, UK.
authors.forename: Elisa
authors.initials: E
authors.lastname: Fontana
authors.affiliation: The Royal Marsden Hospital NHS Foundation Trust, London, UK.
authors.forename: Elizabeth C
authors.initials: EC
authors.lastname: Smyth
authors.affiliation: The Royal Marsden Hospital NHS Foundation Trust, London, UK. david.cunningham@rmh.nhs.uk.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D004938:Esophageal Neoplasms / Q000188:drug therapy* / Q000473:pathology; D004943:Esophagogastric Junction / Q000473:pathology; D006801:Humans; D009362:Neoplasm Metastasis; D013274:Stomach Neoplasms / Q000188:drug therapy*
chemical_list: D000970:Antineoplastic Agents
keywords: Chemoradiation; Chemotherapy; Esophageal adenocarcinoma; Esophagogastric junction; Gastric adenocarcinoma; Neoadjuvant; Perioperative; Targeted agents; Treatment approach