Neoadjuvant Chemotherapy of Nanoparticle Albumin-bound Paclitaxel in Squamous Cell Carcinoma of Esophagus

A Phase II Trial of Neoadjuvant Chemotherapy With Nanoparticle Albumin-bound Paclitaxel and Fluorouracil Followed by Surgery in Patients With Locally Advanced Squamous Cell Carcinoma of Esophagus

Albumin-bound paclitaxel regimen in advanced NSCLC has a better tumor response rate and safety than solvent-based paclitaxel. However, the safety and efficacy is uncertain in neoadjuvant therapy in esophageal cancer. The objective of this single-arm phase II trial was to evaluate the benefit of neoadjuvant chemotherapy with nanoparticle albumin-bound paclitaxel plus 5-fluorouracil in patients with locally advanced esophageal squamous cell carcinoma.

In the past decade, clinical trials have evaluated the role of neoadjuvant chemotherapy, radiation, or both, for patients with surgically resectable esophageal carcinoma, but have all failed to demonstrate a consistent survival benefit. In Eastern countries, preoperative chemotherapy followed by radical surgery became one of the treatment strategies for resectable, clinical stage II or III esophageal cancer. In an effort to improve the efficacy of systemic chemotherapy, we conducted a prospective study to evaluate the regimen of nanoparticle albumin-bound paclitaxel plus 5-fluorouracil as perioperative therapy for patients with resectable esophageal carcinoma.

Inclusion Criteria:

• Histologically confirmed squamous cell carcinoma of the thoracic esophagus, including the gastroesophageal junction (Siewert type I)
• Locally advanced disease that is technically operable with curative intent (R0)
• T3, N0 OR T1-3, N+ OR T4, Nx
• No T1-2, N0
• No inoperable T4 (unequivocal organ involvement)
• No distant metastasis, including M1a lymph node status
• Lymph nodes suspicious of M1a status by CT scan, PET scan, or ultrasound must be verified by fine-needle aspiration cytology
• No carcinoma of the cervical esophagus
• Obstructive tumors allowed

Exclusion Criteria:

• Not suitable to surgery
• cervical Esophageal Carcinoma(distance of incisor tooth<19cm)
• early Esophageal Carcinoma(Stage I)
• complete esophageal obstruction，Esophageal perforation or hematemesis
• other malignant tumors, except for skin basal cell carcinoma, or cervical carcinoma in situ
• pregnant or breast-feeding women or people during the birth-period who refused to take contraceptives
• Uncontrolled seizures or psychiatric diseases, loss of control over their own behavior
• History of serious allergic or castor oil allergy
• Patients who are not suitable to participate in the trial according to researchers