Comparing Paclitaxel Plus Fluorouracil Versus Cisplatin Plus Fluorouracil in Chemoradiotherapy for Locally Advanced Esophageal Squamous Cell Cancer: A Randomized, Multicenter, Phase III Clinical Trial

Abstract

Purpose: This trial aimed to assess the efficacy and safety of the paclitaxel plus fluorouracil regimen versus the cisplatin plus fluorouracil regimen in definitive concurrent chemoradiotherapy (dCRT) in patients with locally advanced esophageal squamous cell carcinoma (ESCC).

Patients and methods: Patients with locally advanced ESCC were enrolled and randomly assigned to either the paclitaxel plus fluorouracil group or the cisplatin plus fluorouracil group. The patients in the paclitaxel plus fluorouracil group were treated with paclitaxel and fluorouracil one cycle per week in dCRT for five cycles followed by paclitaxel and fluorouracil one cycle per month in consolidation chemotherapy for two cycles. The patients in the cisplatin/5-fluorouracil group were treated with cisplatin and fluorouracil one cycle per month in dCRT for two cycles followed by two cycles in consolidation chemotherapy. The radiotherapy dose was 61.2 Gy delivered in 34 fractions. The primary end point was 3-year overall survival (OS).

Results: Four hundred thirty-six patients with ESCC in six centers were recruited at a 1:1 ratio between April 2012 and July 2015. The median follow-up of the surviving patients was 48.7 months (interquartile range, 42.6-60.9). The 3-year OS was 55.4% in the paclitaxel plus fluorouracil group and 51.8% in the cisplatin plus fluorouracil group (hazard ratio, 0.905 [95% CI, 0.698 to 1.172]; P = .448). The 3-year progression-free survival was also not significantly different between the paclitaxel plus fluorouracil group and the cisplatin plus fluorouracil group (43.7% v 45.5%, respectively; hazard ratio, 0.973 [95% CI, 0.762 to 1.243]; P = .828). Compared with the cisplatin plus fluorouracil group, the paclitaxel plus fluorouracil group had significantly lower incidences of acute grade 3 or higher anemia, thrombocytopenia, anorexia, nausea, vomiting, and fatigue (P < .05), but higher incidences of acute grade 3 or higher leukopenia, radiation dermatitis, and radiation pneumonitis (P < .05).

Conclusion: The paclitaxel plus fluorouracil regimen did not significantly prolong the OS compared with the standard cisplatin plus fluorouracil regimen in dCRT in patients with locally advanced ESCC.

Trial registration: ClinicalTrials.gov NCT01591135.

FIG 1.

Trial profile. Four hundred seventy-five patients with esophageal squamous cell carcinoma were assessed for eligibility at registration in seven centers in China. Two hundred nineteen patients were assigned to the cisplatin plus fluorouracil group and 217 patients were assigned to the paclitaxel plus fluorouracil group as an intention-to-treat population.

FIG 2.

(A) Overall survival and (B) progression-free survival in enrolled patients. There was no significant difference between the paclitaxel plus fluorouracil group and the cisplatin plus fluorouracil group in terms of overall survival or progression-free survival. HR, hazard ratio.

FIG 3.

Subgroup analyses of overall survival. The effects of different regimens on overall survival according to the predictive and prognostic factors (sex, age, smoking history, stage, tumor site, Eastern Cooperative Oncology Group (ECOG), tumor length, mean heart dose, and treatment completion) were not significantly different between the two groups. AJCC, American Joint Committee on Cancer.

FIG A1.

(A) Locoregional progression-free survival and (B) metastasis-free survival in enrolled patients. Differences between the paclitaxel plus fluorouracil group and the cisplatin plus fluorouracil group in terms of locoregional progression-free survival (locoregional progression included recurrences at the primary tumor and regional lymph node) and metastasis-free survival (metastases included any site beyond the primary tumor and regional lymph nodes) were not significant. FU, fluorouracil; HR, hazard ratio.