Chemotherapy is one of the primary treatments for patients with advanced esophageal cancer. The first thing you need to know is that “advanced” esophageal cancer is a relative concept, and it is probably more appropriate to call it “progressive esophageal cancer. Doctors often evaluate whether you have a chance for surgery through methods such as enhanced CT.
If you have a chance for surgery, you can usually choose preoperative neoadjuvant therapy (chemotherapy or radiation + chemotherapy) and consider surgery after the mass and metastatic lymph nodes have shrunk; if you don’t have a chance for surgery, you can use palliative chemotherapy (or radiation + chemotherapy) to improve your quality of life and prolong your life.
What are the chemotherapy drugs for esophageal cancer?
Currently, the commonly used chemotherapeutic drugs for esophageal cancer are fluorouracil, platinum, paclitaxel, etc. Anthracyclines such as epirubicin, which were once used, are now less commonly used because of adverse effects such as cardiotoxicity.
Fluorouracil class
Including capecitabine, tegeo, etc.
In a phase II clinical trial, patients with advanced esophageal squamous carcinoma treated with first-line chemotherapy with capecitabine had an efficiency of 57.8%, progression-free survival of 4.7 months, and a median survival time of 11.2 months, with anorexia and neutropenia as common side effects.
Paclitaxel
Including paclitaxel, doxorubicin, and others. These drugs block tumor cell division and proliferation and have anti-multiple tumor effects. These drugs can also enhance the tumor-killing effect of radiotherapy and are suitable for use in combination with radiotherapy. It is easily tolerated for its toxic side effects.
Platinums
Including carboplatin and cisplatin, which inhibit tumor cell DNA replication and damage structures on their cell membranes, they have a strong broad-spectrum anti-cancer ability. Cisplatin is often combined with other chemotherapeutic agents for preoperative neoadjuvant therapy. One study showed a complete remission rate of 41% with a paclitaxel + cisplatin regimen.
Which chemotherapy regimen is right for me?
In China, there is no standard first-line regimen for chemotherapy for advanced esophageal squamous cancer, let alone which regimen is better for which patient.
Different hospitals usually choose 1 to 2 chemotherapy drugs and set the appropriate dose based on previous experience, taking into account your age, height, weight, ECOG score, blood count, liver and kidney function, and tumor load (how much the tumor is harming the body), and repeat every 2 to 4 weeks.
The “paclitaxel+cisplatin” regimen, known as the “TP regimen,” is commonly used at the Peking University Cancer Hospital, where I work, and T is short for paclitaxel and P is short for cisplatin (DDP). T is short for paclitaxel and P is short for cisplatin (DDP). Sometimes the same drug may be substituted, such as paclitaxel for doxorubicin or protein-bound paclitaxel, or cisplatin for carboplatin or nedaplatin, but it is still essentially a TP regimen.
In general, the TP regimen is given in 21-day cycles, and your doctor will give you a TP infusion that lasts for about two days. So, you only have to stay in the hospital for two days per cycle of chemotherapy, and you can stay home for the remaining 19 days to rest. Of course, because of some of the adverse effects of chemotherapy, you may need to come to the hospital regularly for blood tests to monitor potential side effects and to get prompt treatment.
The body has a tolerated dose of chemotherapy, so chemotherapy cycles are limited. Patients with esophageal cancer have been treated with 6 cycles of TP chemotherapy, which is the maximum.
If you experience an intolerable adverse reaction with the drug, you may choose to have the drug reduced or changed to another drug.
Lastly, I would like to remind you that although the common chemotherapy regimens vary from hospital to hospital, your doctor will try to choose the treatment option that is most beneficial to your patient. If you end up at a hospital, it is recommended that you trust your primary care physician and actively cooperate with your treatment.