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Phase I evaluation of TNFerade Biologic plus chemoradiotherapy before esophagectomy for locally advanced resectable esophageal cancer
Gastrointestinal Endoscopy, 04/30/2012
Clinical Article
Chang KJ et al. – Preoperative TNFerade, in combination with chemoradiotherapy, is active and safe at doses up to 4 × 1010 particle units (PU) and is associated with long survival. This regimen warrants additional studies.
Methods- Five weekly injections of TNFerade biologic, dose-escalated logarithmically from 4 × 108 to 4 × 1011 particle units (PU), were given in combination with cisplatin 75 mg/m2 and intravenous 5-fluorouracil 1000 mg/m2/d for 96 hours on days 1 and 29, and concurrent radiation therapy to 45 Gy.
- Surgery was performed 9 to 15 weeks after treatment.
- U.S. multicenter study.
- Primary outcome measures were safety, feasibility, tolerability, and rate of pCR.
- Secondary outcome measures were overall survival (OS) and disease-free survival.
- Twenty-four patients with a median age of 61 years were enrolled; 88% of the patients were men, 21% were stage II, and 79% were stage III.
- Six (29%) had a pCR, observed among 21 patients (20 who underwent esophagectomy and 1 at autopsy).
- Dose-limiting toxicities were not observed.
- The most frequent potentially related adverse events were fatigue (54%), fever (38%), nausea (29%), vomiting (21%), esophagitis (21%), and chills (21%).
- At the top dose of 4 × 1011 PU, thromboembolic events developed in 5 of 8 patients.
- The median OS was 47.8 months.
- The 3- and 5-year OS rates and disease-free survival rates were 54% and 41% and 38% and 38%, respectively.
