The benefit of taxane-based therapies over fluoropyrimidine plus platinum (FP) in the treatment of esophageal cancer: a meta-analysis of clinical studies

Abstract

Purpose: 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.

Patients and methods: 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).

Results: 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, P=0.0008; and overall survival (OS): pooled HR=0.50, P<0.00001) and dCRT (PFS: pooled HR=0.75, P<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, P=0.02; NACRT: pooled HR=0.51, P=0.03; and dCRT: pooled HR=0.73, P<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.

Conclusion: 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.

Keywords: chemotherapy; clinical cancer research; digestive cancer; survival.

Figure 1

The flow chart of study selection.

Figure 2

Analyses of curative effects between taxane-based NACT and FP based NACT in EC. (A) CR; (B) ORR; (C) DCR; (D) R0 resection; (E) pCR; (F) PFS; and (G) OS. Abbreviations: CR, complete response; DCR, disease control rate; EC, esophageal cancer; NACT, neoadjuvant chemotherapy; ORR, objective response rate; OS, overall survival; pCR, pathological complete response; PFS, progression free survival; FP, fluoropyrimidine plus platinum.

Figure 2

Analyses of curative effects between taxane-based NACT and FP based NACT in EC. (A) CR; (B) ORR; (C) DCR; (D) R0 resection; (E) pCR; (F) PFS; and (G) OS. Abbreviations: CR, complete response; DCR, disease control rate; EC, esophageal cancer; NACT, neoadjuvant chemotherapy; ORR, objective response rate; OS, overall survival; pCR, pathological complete response; PFS, progression free survival; FP, fluoropyrimidine plus platinum.

Figure 3

Analyses of curative effects between taxane-based dCRT and FP-based dCRT in EC. (A) CR; (B) ORR; (C) DCR; (D) PFS; and (E) OS. Abbreviations: CR, complete response; DCR, disease control rate; dCRT, definitive chemoradiotherapy; EC, esophageal cancer; ORR, objective response rate; OS, overall survival; PFS, progression free survival.

Figure 3

Analyses of curative effects between taxane-based dCRT and FP-based dCRT in EC. (A) CR; (B) ORR; (C) DCR; (D) PFS; and (E) OS. Abbreviations: CR, complete response; DCR, disease control rate; dCRT, definitive chemoradiotherapy; EC, esophageal cancer; ORR, objective response rate; OS, overall survival; PFS, progression free survival.