Clinical Trials Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Nov 15, 2021; 13(11): 1781-1790
Published online Nov 15, 2021. doi: 10.4251/wjgo.v13.i11.1781
Induction chemotherapy with albumin-bound paclitaxel plus lobaplatin followed by concurrent radiochemotherapy for locally advanced esophageal cancer
Mao-Hui Yan, Fang Liu, Bao-Lin Qu, Bo-Ning Cai, Wei Yu, Xiang-Kun Dai
Mao-Hui Yan, Fang Liu, Bao-Lin Qu, Bo-Ning Cai, Wei Yu, Xiang-Kun Dai, Department of Radiotherapy, The First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, Beijing 100853, China
Author contributions: Yan MH, Liu F, Qu BL, Cai BL, Yu W, and Dai XK contributed equally to this work; Yan MH and Liu F designed the research study; Yan MH, Liu F, Qu BL, Cai BL, Yu W, and Dai XK performed the research; Yan MH, Cai BL, and Yu W contributed analytic tools; Yan MH, Liu F, Qu BL, Cai BL, Yu W, and Dai XK analyzed the data and wrote the manuscript; and all authors have read and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital Institutional Review Board (Approval No. S2016-099-02).
Clinical trial registration statement: This study is registered at Chinese Clinical Trial Registry. The registration identification number is ChiCTR1900025080.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: None.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author at email address. Participants gave informed consent for data sharing.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Fang Liu, MD, Associate Chief Physician, Department of Radiotherapy, the First Medical Center of the Chinese People's Liberation Army (PLA) General Hospital, No. 28 Fuxing Road, Haidian District, Beijing 100853, China. liufangfsq@163.com
Received: June 15, 2021
Peer-review started: June 15, 2021
First decision: July 16, 2021
Revised: July 18, 2021
Accepted: August 23, 2021
Article in press: August 23, 2021
Published online: November 15, 2021
Processing time: 149 Days and 23 Hours
Abstract
BACKGROUND

Albumin-bound paclitaxel (ABP) has been used as second- and higher-line treatments for advanced esophageal cancer, and its efficacy and safety have been well demonstrated. Lobaplatin (LBP) is a third-generation platinum antitumor agent; compared with the first two generations of platinum agents, it has lower toxicity and has been approved for the treatment of breast cancer, small cell lung cancer, and chronic granulocytic leukemia. However, its role in the treatment of esophageal cancer warrants further investigations.

AIM

To investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy (RCT) for locally advanced esophageal cancer.

METHODS

Patients with pathologically confirmed advanced esophageal squamous cell carcinoma (ESCC) at our hospital were enrolled in this study. All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT: ABP 250 mg/m2, ivgtt, 30 min, d1, every 3 wk; and LBP, 30 mg/m2, ivgtt, 2 h, d1, every 3 wk. A total of four cycles were scheduled. The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions, 1.8-2.0 Gy/fraction, and 5 fractions/wk.

RESULTS

A total of 29 patients were included, and 26 of them completed the treatment protocol. After the induction chemotherapy, the objective response rate (ORR) was 61.54%, the disease control rate (DCR) was 88.46%, and the progressive disease (PD) rate was 11.54%; after the concurrent RCT, the ORR was 76.92%, the DCR was 88.46%, and the PD rate was 11.54%. The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo. Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone (P = 0.0024). Non-hematologic toxicities were tolerable, and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis (13.79%). The main hematologic toxicity was neutropenia, and no grade 4 adverse event occurred.

CONCLUSION

Induction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC, with mild adverse effects. Thus, this protocol is worthy of clinical promotion and application.

Keywords: Esophageal squamous cell carcinoma; Esophagus cancer; Induction chemotherapy; Concurrent radiochemotherapy; Radiotherapy; Chemotherapy; Albumin-bound paclitaxel; Lobaplatin

Core Tip: This study aimed to investigate the efficacy and safety of induction chemotherapy with albumin-bound paclitaxel (ABP) plus lobaplatin followed by concurrent radiochemotherapy (RCT) for locally advanced esophageal cancer. A total of 29 patients were included, and 26 of them completed the treatment protocol. Induction chemotherapy with ABP plus lobaplatin followed by concurrent RCT is effective in patients with locally advanced esophageal squamous cell carcinoma, with mild adverse effects. Thus, this protocol is worthy of clinical promotion and application.