Cancer Resources > Cancer News > 2008 > January

Capecitabine and oxaliplatin effective for advanced esophageal cancer

Last Updated: 2008-01-04 15:16:19 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Capecitabine and oxaliplatin are effective alternatives to fluorouracil and cisplatin, respectively, for treating advanced esophagogastric cancer, according to a report in The New England Journal of Medicine for January 3.

The results indicate that "oral capecitabine is at least as effective as infused fluorouracil and that oxaliplatin (which does not require hydration) is at least as effective as cisplatin (which does require hydration) with respect to overall survival," Dr. David Cunningham, from the Royal Marsden Hospital National Health Service Foundation Trust in Surrey and London, UK, and colleagues conclude.

The study involved 1002 patients who were randomized to receive epirubicin in combination with cisplatin plus either fluorouracil (ECF) or capecitabine (ECX) or with oxaliplatin plus either fluorouracil (EOF) or capecitabine (EOX).

As noted, the researchers found that survival was not compromised by substituting capecitabine for fluorouracil or oxaliplatin for cisplatin. In fact, overall survival was significantly longer with EOX than with ECF, although the study was primarily designed to assess noninferiority.

The regimens did not differ significantly in progression-free survival or response rates, the report shows.

In terms of toxicity, capecitabine and fluorouracil appeared comparable, whereas some differences were noted with cisplatin and oxaliplatin. Namely, oxaliplatin was less likely than cisplatin to cause grade 3 or 4 neutropenia, alopecia, renal toxicity, and thromboembolism, but more likely to cause grade 3 or 4 diarrhea and neuropathy.

"The next generation of clinical trials involving patients with esophagogastric cancer will incorporate targeted agents into optimized cytotoxic platforms, such as EOX, in tandem with correlative translational research in order to improve outcomes further," the authors note.

N Engl J Med 2008;358:36-46.

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