Wang Tao, Yu Jie, Liu Min, Chen Yanliang, Zhu Caiyun, Lu Lin, Wang Mingzhu, Min Lingfeng, Liu Xinxin, Zhang Xizhi, Gubat Johannes A, Chen Yong
Department of Medical Oncology, Clinical Medical College, Yangzhou University, Yangzhou, Jiangsu, China,
Department of Medical Oncology, Dalian Medical University, Dalian, Liaoning, China.
Drug Des Devel Ther. 2019 Feb 5;13:539-553. doi: 10.2147/DDDT.S189514. eCollection 2019.
Fluoropyrimidine plus platinum (FP) is currently the standard treatment for esophageal cancer (EC). In recent years, taxane-based chemotherapy has also been used and has shown good efficacy in EC. This study aims to investigate the advantages of taxane-based over FP chemotherapy, as well as discuss its drawbacks, in the treatment of EC.
A literature search was done for studies comparing clinical outcomes between taxane-based and FP chemotherapy in EC. Pooled analyses were performed to compare the efficacy and grade 3/4 adverse events in patients who received neoadjuvant chemotherapy (NACT), neoadjuvant chemoradiotherapy (NACRT), or definitive chemoradiotherapy (dCRT). Subgroup analyses were also conducted in esophageal squamous cell carcinoma (ESCC).
Thirty-one studies with a total of 3,912 patients were included in the analysis. Better long-term survival was found in patients who received taxane-based NACT (progression-free survival (PFS): pooled HR=0.58, =0.0008; and overall survival (OS): pooled HR=0.50, <0.00001) and dCRT (PFS: pooled HR=0.75, <0.0001). In NACRT, taxane-based treatment and FP showed similar efficacy. In ESCC patients, taxane-based treatment showed better OS (NACT: pooled HR=0.57, =0.02; NACRT: pooled HR=0.51, =0.03; and dCRT: pooled HR=0.73, <0.0001) than FP chemotherapy. Furthermore, taxane-based therapy also showed a better short-term response (complete response (CR), objective response rate (ORR), disease control rate (DCR), or pathologic complete response (pCR). However, taxane-based therapy was significantly correlated with a higher incidence of grade 3/4 leukopenia, neutropenia, and diarrhea.
Compared to FP, taxane-based therapy produced better clinical response and outcomes in EC patients receiving NACT or dCRT, and in all types of therapy in patients with ESCC. Taxane-based treatment is associated with more frequent toxicity.
氟尿嘧啶联合铂类（FP）目前是食管癌（EC）的标准治疗方案。近年来，紫杉烷类化疗也被应用于食管癌治疗，并显示出良好疗效。本研究旨在探讨紫杉烷类化疗相较于FP化疗在食管癌治疗中的优势，并讨论其缺点。
检索比较紫杉烷类化疗与FP化疗在食管癌患者中临床结局的研究。对接受新辅助化疗（NACT）、新辅助放化疗（NACRT）或根治性放化疗（dCRT）的患者进行汇总分析，比较疗效及3/4级不良事件。同时也对食管鳞状细胞癌（ESCC）患者进行亚组分析。
共纳入31项研究，总计3912例患者。接受紫杉烷类NACT的患者有更好的长期生存（无进展生存期（PFS）：汇总风险比（HR）=0.58，P=0.0008；总生存期（OS）：汇总HR=0.50，P<0.00001），接受紫杉烷类dCRT的患者也有更好的长期生存（PFS：汇总HR=0.75，P<0.0001）。在NACRT中，紫杉烷类治疗与FP疗效相似。在ESCC患者中，紫杉烷类治疗的OS优于FP化疗（NACT：汇总HR=0.57，P=0.02；NACRT：汇总HR=0.51，P=0.03；dCRT：汇总HR=0.73，P<0.0001）。此外，紫杉烷类治疗的短期反应（完全缓解（CR）、客观缓解率（ORR）、疾病控制率（DCR）或病理完全缓解（pCR））也更好。然而，紫杉烷类治疗与3/4级白细胞减少、中性粒细胞减少及腹泻的发生率显著相关。
与FP相比，紫杉烷类治疗在接受NACT或dCRT的EC患者以及ESCC患者的所有治疗类型中均产生了更好的临床反应和结局。紫杉烷类治疗伴随更频繁的毒性反应。
