Neo-adjuvant chemotherapy with carboplatin, 4-epiadriamycin and teniposide (CET) in locally advanced cancer of the cardia and the lower oesophagus: a phase II study.

Disappointing results after surgery alone for locally advanced adenocarcinoma of the cardia and the distal oesophagus (stage IIIB/IV) prompted us to combine surgery with neo-adjuvant chemotherapy. With a remission rate of about 70% the combination of etoposide, adriamycin and cisplatin (EAP) has been considered to be the superior treatment, but it has inherent severe toxicity. The authors conducted a phase II study of combined treatment with Carboplatin, 4-Epiadriamycin and Teniposide (CET) to ameliorate this toxicity and to evaluate the effectivity of this regimen in patients with these unresectable tumours. A regimen of 4 cycles of Carboplatin 300mg/m2, 4-Epiadriamycin 80mg/m2 and Teniposide 100mg/m2 was administered intravenously. Treatment cycles were repeated every 3 weeks in patients with initially unresectable adenocarcinoma of the gastro-oesophageal junction proven at laparotomy and/or CT scanning. Nineteen patients were studied and 17 underwent a second laparotomy in an attempt to resect the tumour radically. Eleven patients (65%) of the re-explored group achieved tumour reduction, enabling resection with curative intent. Recurrences, however occurred in 9 patients after a median of 9.5 (4-42) months. One patient died postoperatively as a result of pulmonary embolism. Only one patient remained free of disease after 42+ months. Leucopenia and thrombocytopenia of WHO grade 23 occurred in 58% and 37% of the patients, respectively. This regimen appears to be effective in patients with locally advanced adenocarcinoma of the cardia and the distal oesophagus. Although it can be used in an outpatient setting, the overall toxicity is relatively high and the results are comparable with other less toxic regimens.