Source: professional.cancerconsultants.com
Author: staff

Researchers from Germany have reported that Erbitux® (cetuximab) improves response rate, time to disease progression, and overall survival of patients with metastatic squamous cell carcinoma receiving Platinol® (cisplatin) and 5-FU. The details of this study appeared in the October 2009 issue of Annals of Oncology.[1]

Esophageal cancer is relatively common and is very deadly. It 1998 there were approximately 12,300 new cases of esophageal cancer diagnosed in the United States and nearly 12,000 esophageal cancer deaths, making esophageal cancer one of the most deadly of all cancers. Most cancers of the upper two-thirds of the esophagus arise from squamous cells. Cancers of the lower esophagus most often arise from columnar epithelium and are adenocarcinomas. In the recent past, squamous cell cancers made up more than 80% of all esophageal cancers. Over the past two decades, there has been a dramatic increase in the incidence of adenocarcinomas, which now account for one-third to one-half of all esophageal cancers. However, squamous cell carcinoma of the esophagus remains a major problem and is difficult to treat when metastatic. Usual treatment for metastatic squamous cell carcinoma of the esophagus includes a platinum compound and 5-FU.

Erbitux is a chimeric monoclonal antibody that binds to the outer domain of the epidermal growth factor receptor (EGFR). It is currently approved, in combination with radiation therapy, for the treatment of locally or regionally advanced head and neck cancer, or as a single agent in the treatment of advanced, EGFR-expressing head and neck cancer that has failed prior platinum-based therapies. Early studies have suggested activity for Erbitux for treating squamous cell carcinoma of the esophagus.

The current study randomly allocated 62 patients with metastatic squamous cell carcinoma of the esophagus to treatment with Platinol and 5-FU with or without Erbitux. Toxicity of Erbitux included skin rash and diarrhea. The overall response rate of patients receiving Erbitux was 19% compared with 13% for the chemotherapy-alone group. Disease-control rate was 75% for patients receiving Erbitux and 57% for patients receiving chemotherapy alone. The median progression-free survival was 5.9 months for patients receiving Erbitux and 3.6 months for patients receiving chemotherapy alone. Median survival was 9.5 months for patients receiving Erbitux and 5.5 months for patients receiving chemotherapy alone. No KRAS mutations were identified in 37 specimens.

Comments: Erbitux appears to be active for the treatment of squamous cell carcinoma of the esophagus.

Reference:
[1] Lorenzen S, Schuster T, Porschen R, et al. Cetuximab plus cisplatin-5-fluorouracil versus cisplatin-5-fluorouracil alone in first-line metastatic squamous cell carcinoma of the esophagus: a randomized phase II study of the Arbeitsgeminschaft Internistische Onkologie. Annals of Oncology. 2009; 20:1667-1673.