Docetaxel esophageal cancer

Within the multiple subsites of this tumor grouping, most work has been done in esophageal cancer. The large majority of these patients have been treated with paclitaxel in combination with radiation (Table 3). The experience with docetaxel is essentially limited to patients treated on phase I trials for thoracic malignancies that used radiation in combination with docetaxel (68,111). The situation is much the same for both pancreatic and gastric cancers as well. The rationale for looking at combination therapy that incorporates paclitaxel is much the same as in other disease sites, i.e., its activity in systemic disease (112), its potent preclinical radiosensitizing properties (38), and evidence from randomized trials that there is a benefit to combined modality therapy that includes at least radiation and chemotherapy (113-116). 

Docetaxel, another taxane, binds to tubulin to promote microtubule assembly. The pharmacokinetics of docetaxel are best described by a three-compartment model, with an a half-life of 0.08 hours, a 3 half-life of 1.6 to 1.8 hours, and a terminal half-life of 65 to 73 hours.14 Docetaxel has activity in the treatment of breast, non-small cell lung, prostate, bladder, esophageal, stomach, ovary, and head and neck cancers. Dexamethasone, 8 mg twice daily for 3 days starting the day before treatment, is used to prevent the fluid retention syndrome associated with docetaxel and possible hypersensitivity reactions. The fluid... 

There is certainly less data available on the role of concurrent docetaxel with radiation in the treatment of locally advanced nonsmall-cell lung cancer. Koukourakis et al. (66) have reported on their phase I/II experience of administering radiation concurrently with docetaxel for stage IIIB NSCLC. In the phase II portion of their study, 30 mg/m2 of docetaxel was given weekly with concurrent 64 Gy of thoracic radiation. Esophagitis was the main side effect of the regimen wherein 17% of patients needed a two-week treatment delay and another 31 % of patients required minor delays (3-7 d). Thirty-five patients were enrolled and evaluable, and the overall response rate was 80% (34% CR). The median survival was 12 mo, and 1-yr survival rate was reported as being 48%. 

The first compound of the taxanes series, paclitaxel (Taxol), was isolated from the bark of the Western yew tree in 1971. It and its congenic, the semisynthetic docetaxel (Taxotere), exhibit unique pharmacological actions as inhibitors of mitosis, differing from the vinca alkaloids and colchicine derivatives in that they bind to a different site on P-tubulin and promote rather than inhibit microtubule formation. The drugs have a central role in the therapy of ovarian, breast, lung, esophageal, bladder, and head and neck cancers. 

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