Treatment protocols for esophagogastric cancer

INTRODUCTION — The following material represents a subset of chemotherapy and immunotherapy regimens that are used for the treatment of patients with esophageal and gastric cancer, both in the adjuvant/neoadjuvant setting and for advanced disease. This is not an exhaustive list; it includes regimens that are considered by the authors and editors to be commonly used and important for the care of patients with esophagogastric cancer. Additional regimens may be added over time, particularly as treatment for esophagogastric cancer evolves.

This topic review is intended to provide only a listing of chemotherapy and immunotherapy regimens. It does not address the appropriate context for use of these regimens in the care of patients with esophagogastric cancer. Clinicians should refer to the individual disease-oriented topic reviews that discuss the use of these protocols in appropriate clinical situations:

●(See "Radiation therapy, chemoradiotherapy, neoadjuvant approaches, and postoperative adjuvant therapy for localized cancers of the esophagus".)

●(See "Adjuvant and neoadjuvant treatment of gastric cancer".)

●(See "Initial systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer".)

These tables are provided as examples of how to administer these regimens; there may be other acceptable methods. All chemotherapy and immunotherapy regimens must be administered by clinicians who are trained in the use of chemotherapy and immunotherapy. The clinician is expected to use his or her independent medical judgment in the context of individual circumstances to make adjustments, as necessary.

REGIMENS

Chemotherapy alone

Adjuvant capecitabine plus oxaliplatin (CAPOX) for stage II to III gastric cancer —  (table 1)

Capecitabine plus oxaliplatin advanced esophagogastric cancer —  (table 2)

Docetaxel, cisplatin, and fluorouracil (DCF) —  (table 3)

Modified docetaxel, cisplatin, and fluorouracil (modified DCF) —  (table 4)

Epirubicin, cisplatin, and fluorouracil (ECF) —  (table 5)

Epirubicin, cisplatin, and capecitabine (ECX) —  (table 6)

Epirubicin, oxaliplatin, and capecitabine (EOX) —  (table 7)

Perioperative docetaxel, oxaliplatin, fluorouracil, and leucovorin (FLOT4) —  (table 8)

FOLFIRI (fluorouracil plus leucovorin and irinotecan) — Although the published experience in advanced esophagogastric cancer is with slightly different regimens, most clinicians use the same FOLFIRI regimen as is used for advanced colorectal cancer (table 9). (See "Initial systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer", section on 'Irinotecan-containing regimens'.)

Irinotecan plus cisplatin —  (table 10)

Modified FOLFOX6 and modified FOLFOX7 (fluorouracil plus leucovorin and oxaliplatin) — Although the published experience in advanced esophagogastric cancer is with slightly different regimens, most clinicians use the same modified FOLFOX6 and FOLFOX7 regimens as are used for colorectal cancer (table 11 and table 12). (See "Initial systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer", section on 'Oxaliplatin combinations'.)

Ramucirumab plus paclitaxel for advanced esophagogastric adenocarcinoma —  (table 13)

Single-agent ramucirumab for advanced esophagogastric adenocarcinoma —  (table 14)

Trastuzumab-containing regimens for HER2-positive advanced adenocarcinomas — (See "Initial systemic therapy for locally advanced unresectable and metastatic esophageal and gastric cancer", section on 'HER2-overexpressing adenocarcinomas'.)

Trastuzumab plus capecitabine and cisplatin —  (table 15)

Trastuzumab plus fluorouracil and cisplatin —  (table 16)

FOLFOX plus trastuzumab —  (table 17)

Capecitabine and oxaliplatin (CAPOX) plus trastuzumab —  (table 18)

Concurrent chemoradiotherapy

Weekly carboplatin plus paclitaxel with concurrent radiotherapy —  (table 19)

Trimodality therapy with cisplatin plus fluorouracil and concurrent radiotherapy followed by surgery —  (table 20)

Immunotherapy

Pembrolizumab monotherapy for PD-L1-overexpressing or microsatellite-unstable (mismatch repair-deficient) advanced cancer —  (table 21)

Adjuvant nivolumab for resected esophageal or gastroesophageal cancer —  (table 22)

Systemic therapy

Pembrolizumab plus FOLFOX and trastuzumab —  (table 23)

Pembrolizumab plus CAPOX (capecitabine and oxaliplatin) and trastuzumab —  (table 24)

ACKNOWLEDGMENT — The UpToDate editorial staff acknowledges Scott M Wirth, PharmD, BCOP, who contributed to an earlier version of this topic review.