P-069 Neoadjuvant chemotherapy for esophageal cancer: comparison of DCS (DTX/CDDP/S-1) chemotherapy with FAN (5-FU/ADM/Nedaplatin) chemotherapy

Abstract

Introduction: A recent meta-analysis clearly demonstrated the survival benefits of neoadjuvant chemotherapy (NAC) over surgery alone in patients with resectable esophageal cancer. However, recommended regimen remains unclear. The aim of the study was to evaluate the efficacy of docetaxel, cisplatin, and S-1 (DCS) chemotherapy to compare with 5-fluorouracil, doxorubicin, and nedaplatin (FAN) chemotherapy in a prospective cohort study. Methods: Since April 2002, we have performed a prospective cohort study of NAC in patients with esophageal cancer more than cStage II. Initially, the FAN chemotherapy has been adopted between 2002 and 2012. From 2013, we changed the NAC regimen from the FAN chemotherapy to the DCS chemotherapy in order to improve the prognosis. Outcomes of the treatment for DCS group (n = 14) were compared with FAN group (n = 37). In DCS group's patients, cStage II, III, and IV diseases were found in 4, 7, and 3 respectively, whereas the respective number was 10, 24, and 3 in the FAN group's patients. Results: Partial response rate (85.7%) of DCS group was significantly higher than that (48.6%) of FAN group (p = 0.016). Additionally, primary tumor complete response rate (42.9%) of DCS group was significantly higher than that (5.4%) of FAN group (p = 0.003). The Toxicity of grade 3 or higher developed in 7 (50.0%) in DCS group and 12 (32.4%) in FAN group. The completion of planned chemotherapy was performed in 8 (85.7%) of DCS group and 30 (81.1%) of FAN group. There were no treatment-related deaths during the chemotherapy in two groups. The R0 resection rate was 90.9% of DCS group and 86.5% of FAN group. The surgery-related mortality rate was 70.0% and 68.6% in DCS and FAN groups, respectively. There were not significantly different between the 2 groups. Conclusion: The neoadjuvant DCS chemotherapy for initially resectable esophageal cancer shows high partial response and primary tumor complete response rates compared to FAN chemotherapy. The DCS chemotherapy may be a promising neoadjuvant chemotherapy for esophageal cancer.