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Esophageal cancer

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Chemotherapy for esophageal cancer

Chemotherapy uses anticancer, or cytotoxic, drugs to destroy cancer cells. Chemotherapy is commonly used to treat esophageal cancer. Your healthcare team will consider your personal needs to plan the drugs, doses and schedules of chemotherapy. You may also receive other treatments.

Chemotherapy for esophageal cancer is usually a systemic therapy. Most chemotherapy drugs are given as an injection into a vein (intravenous, or IV). The drugs then travel through the bloodstream to reach and destroy cancer cells all over the body, including those that may have broken away from the primary tumour in the esophagus.

Chemotherapy may be used in the following ways to treat esophageal cancer.

Chemoradiation

Chemotherapy is often used as part of chemoradiation to treat esophageal cancer. Chemoradiation is treatment that combines chemotherapy with radiation therapy. Chemotherapy is given during the same time period as radiation therapy.

Primary chemoradiation

Primary chemoradiation means that chemoradiation is given as the main treatment. It may be offered if you can’t have surgery, or you choose not to have surgery. Surgery may not be possible because the tumour cannot be removed (is unresectable) or you aren’t healthy enough to have surgery.

Common combinations of chemotherapy drugs used as a part of primary chemoradiation to treat esophageal cancer are:

  • 5-fluorouracil (Adrucil, 5-FU) and cisplatin (Platinol AQ)
  • capecitabine (Xeloda) and cisplatin
  • 5-fluorouracil and oxaliplatin (Eloxatin)
  • capecitabine and oxaliplatin
  • paclitaxel (Taxol) and carboplatin (Paraplatin, Paraplatin AQ)

Other combinations of drugs used in primary chemoradiation include:

  • paclitaxel and cisplatin
  • docetaxel (Taxotere) and cisplatin
  • irinotecan (Camptosar) and cisplatin
  • 5-fluorouracil and paclitaxel
  • capecitabine and paclitaxel
  • 5-fluoruracil and docetaxel
  • capecitabine and docetaxel

Neoadjuvant chemoradiation

Neoadjuvant chemoradiation is chemotherapy given along with radiation therapy to shrink a tumour before surgery.

Common combinations of chemotherapy drugs used as part of neoadjuvant chemoradiation to treat esophageal cancer are:

  • 5-fluorouracil and cisplatin
  • capecitabine and cisplatin
  • paclitaxel and carboplatin
  • 5-fluorouracil and oxaliplatin
  • capecitabine and oxaliplatin

Other combinations of drugs used in neoadjuvant chemoradiation include:

  • irinotecan and cisplatin
  • 5-fluoruracil and docetaxel
  • capecitabine and docetaxel
  • 5-fluorouracil and paclitaxel
  • capecitabine and paclitaxel

Chemotherapy

Chemotherapy may be used alone to treat esophageal cancer. It may be given before surgery (called neoadjuvant chemotherapy) and after surgery (called adjuvant chemotherapy), or it may be the main treatment given (primary chemotherapy).

Neoadjuvant and adjuvant chemotherapy

Chemotherapy can be used to treat adenocarcinoma of the esophagus. As neoadjuvant chemotherapy, it is given to shrink an adenocarcinoma before surgery. It is given again after surgery as adjuvant chemotherapy to destroy cancer cells left behind and lower the risk that cancer will come back, or recur.

The most common combinations of drugs used in neoadjuvant and adjuvant chemotherapy for adenocarcinoma are:

  • ECF – epirubicin (Pharmorubicin), cisplatin and 5-fluorouracil
  • ECX – epirubicin, cisplatin and capecitabine
  • epirubicin, oxaliplatin (Eloxatin) and 5-fluorouracil
  • epirubicin, oxaliplatin and capecitabine

Primary chemotherapy

Primary chemotherapy means that chemotherapy is given as the main treatment. It may be used for stage IV esophageal cancer or if you aren’t healthy enough to have surgery or chemoradiation.

Sometimes chemotherapy is given alone to relieve pain or control the symptoms of advanced esophageal cancer. This is called palliative chemotherapy.

First-line chemotherapy combinations

The following are the first, most common or preferred combinations of drugs used in primary chemotherapy for esophageal cancer:

  • cisplatin and 5-fluorouracil
  • 5-fluorouracil, cisplatin and docetaxel
  • ECF – epirubicin, cisplatin and 5-fluorouracil
  • ECX – epirubicin, cisplatin and capecitabine
  • EOX – epirubicin, oxaliplatin and capecitabine
  • DCF – docetaxel, cisplatin and 5-fluorouracil
  • 5-fluorouracil, carboplatin and docetaxel
  • 5-fluorouracil, oxaliplatin and docetaxel
  • 5-fluorouracil, oxaliplatin and epirubicin
  • capecitabine and cisplatin
  • 5-fluorouracil and oxaliplatin
  • capecitabine and oxaliplatin
  • 5-fluorouracil and irinotecan

Other drug combinations that may be used for first-line chemotherapy include:

  • paclitaxel and cisplatin
  • paclitaxel and carboplatin
  • docetaxel and cisplatin
  • docetaxel and irinotecan

Second-line chemotherapy combinations

The following drugs or combinations of drugs may be used in primary chemotherapy for esophageal cancer if the first-line chemotherapy drugs don’t work or stop working:

  • docetaxel
  • paclitaxel
  • irinotecan
  • irinotecan and cisplatin
  • irinotecan and 5-fluorouracil
  • irinotecan and capecitabine
  • irinotecan and docetaxel

Other drugs or combinations of drugs that may be used as second-line chemotherapy are:

  • gemcitabine (Gemzar), 5-fluorouracil and leucovorin (folinic acid)
  • mitomycin (Mutamycin) and irinotecan
  • mitomycin, cisplatin and 5-fluorouracil
  • mitomycin and 5-fluorouracil

Information about specific cancer drugs

Details on specific drugs change quite regularly. Find out more about sources of drug information and where to get details on specific drugs.

Questions to ask about chemotherapy

Find out more about chemotherapy. To make the decisions that are right for you, ask your healthcare team questions about chemotherapy.

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