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.

Chemotherapy drugs used to treat esophageal cancer are usually given in combination. Research has shown that this is more effective than giving them as single drugs.

The most common chemotherapy drugs used to treat esophageal cancer are:

• capecitabine (Xeloda)
• cisplatin and capecitabine
• cisplatin and etoposide (Vepesid)
• cisplatin and fluorouracil
• cisplatin and irinotecan
• carboplatin and fluorouracil
• carboplatin and irinotecan
• carboplatin and paclitaxel
• epirubicin, carboplatin and fluorouracil
• epirubicin, carboplatin and capecitabine
• epirubicin, cisplatin and capecitabine
• epirubicin, cisplatin and fluorouracil
• fluorouracil and leucovorin
• docetaxel (Taxotere), oxaliplatin, fluorouracil and leucovorin
• oxaliplatin, fluorouracil and leucovorin
• oxaliplatin and capecitabine

There are no standard treatments for esophageal cancer that does not respond to drugs used in earlier treatments or if it comes back. You may be given the same drugs that you were given before, or different drugs. The following drugs or drug combinations may be used:

• cyclophosphamide (Procytox), doxorubicin and vincristine
• etoposide, leucovorin, fluorouracil
• epirubicin, oxaliplatin and fluorouracil
• epirubicin, oxaliplatin and capecitabine
• irinotecan, fluorouracil and leucovorin
• docetaxel
• paclitaxel
• irinotecan

Lonsurf (trifluridine/tipiracil) may be used to treat recurrent or metastatic adenocarcinoma tumours at the gastroesophageal (GE) junction. It is used after you have had at least 2 different types of chemotherapy, including oxaliplatin and fluorouracil, along with docetaxel or paclitaxel, or irinotecan.

Targeted therapy drugs may be used in combination with some chemotherapy drugs for locally advanced or metastatic adenocarcinoma tumours at the gastroesophageal (GE) junction.

An immunotherapy drug, nivolumab (Opdivo) may be given with cisplatin or carboplatin and fluorouracil for advanced or metastatic tumours at the gastroesophageal (GE) junction, or for adenocarcinoma tumours of the esophagus.

Side effects can happen with any type of treatment for esophageal cancer, but everyone's experience is different. Some people have many side effects. Other people have few or none at all.

Chemotherapy may cause side effects because it can damage healthy cells as it kills cancer cells. If you develop side effects, they can happen any time during, immediately after or a few days or weeks after chemotherapy. Sometimes late side effects develop months or years after chemotherapy. Most side effects go away on their own or can be treated, but some side effects may last a long time or become permanent.

Side effects of chemotherapy will depend mainly on the type of drug, the dose, whether or not radiation therapy is given at the same time as chemotherapy and your overall health. Some common side effects of chemotherapy drugs used for esophageal cancer are:

• low blood cell counts
• nausea and vomiting
• difficulty swallowing
• sore mouth and throat
• fatigue
• loss of appetite and taste changes
• diarrhea
• constipation
• skin problems
• hair loss

Tell your healthcare team if you have these side effects or others you think might be from chemotherapy. The sooner you tell them of any problems, the sooner they can suggest ways to help you deal with them.

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

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