ARE ALL PLATINUM AGENTS INTERCHANGEABLE IN ESOPHAGEAL SQUAMOUS-CELL CARCINOMA (SCC)? A RETROSPECTIVE ANALYSIS

Introduction: Platinum agents are a paramount class of drug in SCC treatment. Cisplatin and carboplatin became the preferred choices in different squamous-cell tumors, such as head and neck and cervical tumors. Yet, Oxaliplatin is highly active in many gastrointestinal malignancies, like esophageal and gastric adenocarcinoma. We aimed to evaluate the efficacy of different platinum agents in esophageal SCC. Methods: We retrospectively analyzed patients with metastatic / recurrent esophageal SCC treated in the first-line setting with a combination regimen including a platinum at a large cancer center. Three groups were identified: Group A, treated with Carboplatin plus Paclitaxel; Group B, treated with an Oxaliplatin regimen (mFOLFOX, CAPOX or mFLOX); Group C treated with Cisplatin plus 5-FU. Our primary endpoint was to compare progression-free survival (PFS) and overall survival (OS) between groups. Descriptive statistics were used to describe main characteristics. Kaplan-Meir and log-rank were used to estimate and compare survival across groups. Chi-square and Fisher were used to compare categorical variables. Results: Between Jan/2010 and Dec/2017, sixty-seven patients met our inclusion criteria. Median follow-up time was 59m. Groups A, B and C had 31 (46.3%), 16 (23.9%) and 20 (29.9%) patients respectively. Median age was 65y, 66.5y and 60y for each group. Patients > 65y were 17 (54.8%), 9 (56.3%) and 7 (35%) across groups A, B, C (p = 0.33). ECOG PS was available in 61 cases. ECOG 0-1 was described in 18 (69.2%), 16 (100%) and 15 (78.9%) in each group. Importantly, eight pts (30.7%) had ECOG 2-3 in group A (p = 0.23).PFS was 4.1m, 6.4m and 5.9m in groups A, B and C respectively (p = 0.19). Numerically, more patients in group A stopped chemotherapy due to performance deterioration (A: 40.7%, B: 20%, C: 25%, p = 0.36). OS was 7.1m, 18.8m and 12.1m across groups A, B and C (p = 0.05). Fewer patients in group A received second-line chemotherapy (A: 35.5%, B: 66.7%, C: 75%, p = 0.012). Conclusion: In our retrospective analysis, oxaliplatin-based regimens were effective in esophageal SCC. PFS was similar across different regimens. Importantly, more patients in groups B and C underwent second-line treatment and had better performance status. Our analysis has methodological limitations and group imbalances. Nevertheless, we would consider oxaliplatin regimens as an alternative in first-line treatment of esophageal SCC.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
23 October 2019