Induction Chemotherapy for Locally Advanced Esophageal Cancer

The goal of the study is to evaluate mFOLFOX6 (5-Fluorouracil, Leucovorin and Oxaliplatin) chemotherapy as induction treatment prior to standard neoadjuvant chemoradiation to decrease the rate of distant recurrence among patients with locally advanced esophageal cancer. mFOLFOX6 is frequently used to treat metastatic esophageal cancer because of its high response rate in this setting. It has shown promising efficacy in several trials of patients with advanced esophageal cancer and it is the most commonly used combination regimen for this group of patients in the United States.

The investigators propose treating a sample of 40 patients with 3 cycles of induction mFOLFOX6 chemotherapy over six weeks followed by standard chemoradiation and surgery. The investigators hypothesize that patients who undergo induction chemotherapy with mFOLFOX6 prior to standard neoadjuvant chemoradiation and surgery will have a lower rate of distant disease recurrence compared to standard neoadjuvant chemoradiation and surgery.

Inclusion criteria

• Must have histologically proven adenocarcinoma, squamous cell carcinoma or undifferentiated carcinoma of the esophagus, GE junction and/or gastric cardia.
• Must have potentially resectable disease.
• Must have ECOG performance status 0 or 1.
• Must have adequate organ function as defined by the following criteria:

• ANC ≥ 1,500/mm3
• Platelet count ≥ 100,000/mm3
• Creatinine (Cr) ≤ 1.5 mg and/or creatinine clearance ≥ 60cc/min.
• Total bilirubin must be ≤ 1.5 x ULN unless the patient has a chronic grade 1 bilirubin elevation due to Gilbert's disease or similar syndrome due to slow conjugation of bilirubin.
• Alkaline phosphatase must be ≤ 2 x ULN.
• AST & ALT must be ≤ 3 x ULN.
• Men and women of reproductive potential must agree to use an effective contraception method
• Must be willing and able to provide written informed consent
• Must be ≥ 18 years or older

Exclusion criteria

• Prior chemotherapy, thoracic radiotherapy or prior surgical resection for an esophageal tumor.
• Known distant metastases.
• Patients with prior malignancies are eligible if they have been disease-free for > 5 years and are deemed by their physician to be at low risk for recurrence. Patients with squamous or basal cell carcinoma of the skin, melanoma in situ, carcinoma in situ of the cervix, or carcinoma in situ of the colon or rectum that have been effectively treated are eligible, even if these conditions were diagnosed within 5 years prior to randomization.
• Known ≥ grade 2 neuropathy.
• Known non-malignant systemic disease (cardiovascular, renal, hepatic, etc.) that would preclude any of the study therapy drugs.
• Known psychiatric or addictive disorders or other conditions that, in the opinion of the investigator, would preclude them from meeting the study requirements.
• Women who are pregnant or nursing.
• Women and men of reproductive potential who are expecting to conceive or father children.