Neoadjuvant chemotherapy with docetaxel, nedaplatin, and fluorouracil for resectable esophageal cancer: A phase II study.

Cisplatin plus 5-fluorouracil is regarded as standard neoadjuvant chemotherapy for esophageal squamous cell carcinoma (ESCC) in Japan, but the prognosis remains poor. We have previously described how definitive chemoradiotherapy with docetaxel, nedaplatin, and 5-fluorouracil (DNF) led to a very high response rate and promising survival times. We therefore undertook a phase II trial to evaluate the feasibility and efficacy of neoadjuvant DNF. The study included patients with clinical stage Ib-III ESCC. Chemotherapy consisted of i.v. docetaxel (30 mg/m2 ) and nedaplatin (50 mg/m2 ) on days 1 and 8, and a continuous infusion of 5-fluorouracil (400 mg/m2 /day) on days 1-5 and 8-12, every 3 weeks. After three courses of chemotherapy, esophagectomy was carried out. The primary end-point was the completion rate of the protocol treatment. Twenty-eight patients were enrolled (cStage Ib/II/III, 2/3/23) and all received at least two cycles of chemotherapy. Twenty-five patients underwent surgery, all of whom achieved an R0 resection, leading to a completion rate of 89.3%. The overall response rate was 87.0%. A pathological complete response was confirmed in eight (32.0%) cases. Grade 3/4 adverse events included leukopenia (32.1%), neutropenia (39.3%), febrile neutropenia (10.7%), thrombocytopenia (10.7%), and diarrhea (14.3%), but were manageable. Treatment-related deaths and major surgical complications did not occur. Estimated 2-year progression-free and overall survival rates were 70.4% and 77.2%, respectively. Thus, DNF therapy was well tolerated and deemed feasible, with a strong tumor response in a neoadjuvant setting for ESCC. This trial is registered with the University Hospital Medical Information Network (UMIN ID: 000014305).

[A case of liver metastasis from gallbladder cancer with marked response to arterial infusion chemotherapy].

The patient was a 68-year-old woman who visited a nearby clinic with a chief complaint of right hypochondrial pain. A mass lesion in the gallbladder was found by ultrasonography. She was referred to our hospital for further examination and was diagnosed with gallbladder cancer. Cholecystectomy and bile duct resection were performed. Six months after the surgery, multiple liver metastases were found. A subcutaneous implant reservoir was placed in the hepatic artery from the right femoral artery. After arterial infusion chemotherapy by 5-FU and CDDP, or 5-FU alone, liver metastasis markedly responded and became undetectable, and therapy was therefore discontinued. The patient has been disease-free without any sign of recurrence for 7 months after CR was achieved. It is suggested that arterial infusion chemotherapy is useful and safe for the treatment of liver metastasis from gallbladder cancer.