Taxol returns.

Top Line: RTOG 85-01, besides the whole notorious 0% survival in the radiation arm thing, established cisplatin and fluorouracil as the standard chemotherapy for locally advanced esophageal cancer.
The Study: Like Mike Krzyzewski, nothing has really bested it since. Back in the cetuximab era, adding cetuximab to cis/FU in SCOPE1 or to cis/paclitaxel in the analogous RTOG 0436 didn’t make a dent. Honing in on the RTOG’s switcheroo of paclitaxel for FU in 0436, there has been growing interest in incorporating a taxane into chemo regimens (hey, it worked with FLOT). Patients with locally-advanced esophageal squamous cell carcinoma (SCC) receiving definitive radiation of 61.2 Gy in 34 fractions were enrolled in ESO-Shanghai 1 and randomized to concurrent and adjuvant [1] cisplatin/FU or [2] paclitaxel/FU. Replacing cisplatin with paclitaxel sadly did not improve overall survival at 3 years at 52-55%, though both impressive. Overall the rate of grade 3+ toxicity was similar (50%), but not surprisingly cisplatin had higher rates of heme and GI toxicity while paclitaxel had higher rates of pneumonitis and skin toxicity.
Bottom Line: Among patients with locally-advanced esophageal SCC receiving definitive chemoradiation, substitution of a taxane for good ole’ cisplatin / FU failed to improved survival or toxicity rates. | Chen, J Clin Oncol 2019


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