A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer

J. A. Ajani, L. Xiao, J. A. Roth, W. L. Hofstetter, G. Walsh, R. Komaki, Z. Liao, D. C. Rice, A. A. Vaporciyan, D. M. Maru, J. H. Lee, M. S. Bhutani, A. Eid, J. C. Yao, A. P. Phan, A. Halpin, A. Suzuki, T. Taketa, P. F. Thall, S. G. Swisher

Research output: Contribution to journalArticle

59 Scopus citations

Abstract

Background: The contribution of induction chemotherapy (IC) before preoperative chemoradiation for esophageal cancer (EC) is not known. We hypothesized that IC would increase the rate of pathologic complete response (pathCR). Methods: Trimodality-eligibile patients were randomized to receive no IC (Arm A) or IC (oxaliplatin/FU; Arm B) before oxaliplatin/FU/radiation. Surgery was attempted ~5-6 weeks after chemoradiation. The pathCR rate, post-surgery 30-day mortality, overall survival (OS), and toxic effects were assessed. Bayesian methods and Fisher's exact test were used. Results: One hundred twenty-six patients were randomized dynamically to balance the two arms for histology, baseline stage, gender, race, and age. Fifty-five patients in Arm A and 54 in Arm B underwent surgery. The median actuarial OS for all patients (54 deaths) was 45.62 months [95% confidence interval (CI), 27.63-NA], with median OS 45.62 months (95% CI 25.56-NA) in Arm A and 43.68 months (95% CI 27.63-NA) in Arm B (P = 0.69). The pathCR rate in Arm Awas 13% (7 of 55) and 26% (14 of 54) in Arm B (two-sided Fisher's exact test, P = 0.094). Safety was similar in both arms. Conclusions: These data suggest that IC produces non-significant increase in the pathCR rate and does not prolong OS. Further development of IC before chemoradiation may not be beneficial. Clinical trial no.: NCT 00525915 (www.clinicaltrials.gov).

Original languageEnglish (US)
Pages (from-to)2844-2849
Number of pages6
JournalAnnals of Oncology
Volume24
Issue number11
DOIs
StatePublished - Nov 2013

Keywords

  • Chemoradiation
  • Esophageal carcinoma
  • Esophageal preservation
  • Induction chemotherapy
  • Pathologic complete response
  • Randomized trial

ASJC Scopus subject areas

  • Oncology
  • Hematology

Fingerprint Dive into the research topics of 'A phase II randomized trial of induction chemotherapy versus no induction chemotherapy followed by preoperative chemoradiation in patients with esophageal cancer'. Together they form a unique fingerprint.

Cite this