Neoadjuvant chemoradiation +/- surgery for resectable cancer

5-FU + Cisplatin + RT
5-FU 800 mg/m2/d civi d1-5 starting on d1, 22, 43, 64, 92
Cisplatin (CDDP) 15 mg/m2/d iv over 1 h d1-5 starting on d1, 22, 43, 64, 92
Radiotherapy 2 Gy/d to 66 Gy over 6.5 weeks

Bedenne L et al. Chemoradiation followed by surgery compared with chemoradiation alone in squamous cancer of the esophagus: FFCD 9102. J Clin  Oncol 2007; 25:1160 (link to the article).

5-FU + Cisplatin + RT + Surgery
5-FU 15 mg/kg/d iv over 16 hours d1-5 week 1 and 6
Cisplatin (CDDP) 75 mg/m2 iv over 8 hours d7 week 1 and 6
Concurrent radiotherapy 2.67 Gy/d to 40 Gy over 3 weeks
Surgery

Walsh TN et al. A comparison of multimodal therapy and surgery for esophageal adenocarcinoma. N Eng J Med 1996; 335:462 (link to the article).

5-FU + Cisplatin + Vinblastine + RT + Surgery
5-FU 300 mg/m2/d civi d1-21
Cisplatin (CDDP) 20mg/m2/d civi d1-5 and 17-21
Vinblastine 1 mg/m2/d iv bolus d1-4 and 17-20
Concurrent radiotherapy 45 Gy
Surgery

Urba SG et al. Randomized trial of preoperative chemoradiation versus surgery alone in patients with locoregional esophageal carcinoma. J Clin Oncol 2001; 19:305 (link to the article).

Perioperative chemotherapy for resectable adenocarcinoma of esophagogastric junction and lower esophagus (back to top)

ECF + surgery + ECF
Epirubicin 50 mg/m2 iv d1
Cisplatin (CDDP) 60 mg/m2 iv d1
5-FU 200 mg/m2/d civi
Q3w x 3 cycles
Surgery 3-6 weeks after chemotherapy
6-12 weeks after surgery, repeat the chemotherapy:
Epirubicin 50 mg/m2 iv d1
Cisplatin (CDDP) 60 mg/m2 iv d1
5-FU 200 mg/m2/d civi
Q3w x 3 cycles

Cunningham D et al. Perioperative chemotherapy versus surgery alone for resectable gastroesophageal cancer. N Eng J Med 2006; 355:11 (link to the article).

FP + Surgery +/- FP
5-FU 800 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv over 1 h d1 or d2
Q4w x 2-3 cycles 
Surgery 4-6 weeks after chemotherapy
4-6 weeks after surgery, repeat the chemotherapy if response to preoperative chemotherapy or stable disease with pN+:
5-FU 800 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv over 1 h d1 or d2
Q4w x 3-4 cycles

Boige V et al. Final results of a randomized trial comparing preoperative 5-fluorouracil  (F) / cisplatin (P) to surgery alone in adenocarcinoma of stomach and lower esophagus (ASLE): FNLCC ACCORD07-FFCD 9703 trial. 2007 ASCO annual meeting. Abstract 4510 (link to the abstract). 

Concurrent chemoradiation for locally advanced cancer (back to top)

5-FU + Cisplatin + RT
5-FU 1000 mg/m2/d civi d1-4 of week 1, 5, 8 and 11
Cisplatin (CDDP) 75 mg/m2 iv d1 of week 1, 5, 8 and 11
Radiotherapy 50 Gy

Herskovic A et al. Combined chemotherapy and radiotherapy compared with radiotherapy alone in patients with cancer of the esophagus. N Eng J Med 1992; 326:1593 (link to the article).

5-FU + Cisplatin
5-FU 1000 mg/m2/d civi d1-5
Cisplatin (CDDP) 100 mg/m2 iv d1
Q3w

Bleiberg, H et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer 1997; 33:1216 (link to the article).

Cisplatin + Paclitaxel
Cisplatin (CDDP) 75 mg/m2 iv d2
Paclitaxel (Taxol) 200 mg/m2 civi over 24hrs d1
Q3w
G-CSF support

Ilson, DH et al. A phase II trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J 2000; 6:316 (link to the article).

Cisplatin + Irinotecan
Cisplatin (CDDP) 30 mg/m2 iv
Irinotecan (Camptosar, CPT-11) 65 mg/m2 iv
Qw

Ilson, DH et al. Phase II trial of weekly irinotecan plus cisplatin in advanced esophageal cancer. J Clin Oncol 1999; 17:3270 (link to the article).

Epirubicin + Cisplatin + 5-FU (ECF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi for 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article). 

Ross, P et al. Prospective randomized trial comparing mitomycin, cisplatin, and protracted venous-infusion fluorouracil (PVI 5-FU) with epirubicin, cisplatin, and PVI 5-FU in advanced esophagogastric cancer. J Clin Oncol 2002; 20:1996 (link to the article).

Epirubicin + Cisplatin + Capecitabine (ECX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Cisplatin (CDDP) 60 mg/m2 iv d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Oxaliplatin + Capecitabine
Oxaliplatin (Eloxatin) 130 mg/m2 iv d1
Capecitabine (Xeloda) 850-1000 mg/m2 po bid x 14 days
Q3w

Meerten EV et al. First-line treatment with oxaliplatin and capecitabine in patients with advanced or metastatic eosophageal cancer: a phase II study. Br J Cancer 2007; 96:1348 (link to the article). 

Jatoi A et al. Oxaliplatin and capecitabine in patients with metastatic adenocarcinoma of the esophagus, gastroesophageal junction and gastric cardia: a phase II study from the North Central Cancer Treatment Group. Ann Oncol 2006; 17:29 (link to the article) 

Epirubicin + Oxaliplatin + 5-FU (EOF)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
5-FU 200 mg/m2/d civi x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Epirubicin + Oxaliplatin + Capecitabine (EOX)
Epirubicin 50 mg/m2 iv bolus d1 q3w x 8 cycles
Oxaliplatin (Eloxatin) 130 mg/m2 iv over 2 hours d1 q3w x 8 cycles
Capecitabine (Xeloda) 625 mg/m2 po bid x 6 months

Cunningham D et al. Capecitabine and oxaliplatin for advanced esophagogastric cancer. N Eng J Med 2008; 358:36 (link to the article).

Paclitaxel
Paclitaxel (Taxol) 250 mg/m2 civi over 24 hrs
Q3w
Filgrastim (Neupogen) support

Ajani, JA et al. Activity of taxol in patients with squamous cell carcinoma and adenocarcinoma of the esophagus. J Natl Cancer Inst 1994; 86:1086 (link to the article).

Vinorelbine
Vinorelbine (Navelbine) 25 mg/m2 iv
Qw

Conroy, T et al. Phase II trial of vinorelbine in metastatic squamous cell esophageal carcinoma. European Organization for Research and Treatment of Cancer Gastrointestinal Treat Cancer Cooperative Group. J Clin Oncol 1996; 14:164 (link to the article).