Weekly cisplatin and nab-paclitaxel neoadjuvant chemoradiotherapy increases pathological complete response in locally...

Although neoadjuvant chemoradiotherapy (nCRT) is the standard treatment regimen for patients with locally advanced esophageal squamous cell carcinoma (LA-ESCC), no consensus exists regarding the optimal chemotherapy regimen. The present study aimed to compare the safety/efficacy of weekly (QW) vs. triweekly (Q3W) cisplatin/nab-paclitaxel nCRT in LA-ESCC. This retrospective study analyzed 136 patients with LA-ESCC who underwent esophagectomy after nCRT (QW, n=32; Q3W, n=104). The data included pathological complete response (pCR), major pathological response (MPR), toxicity, survival and postoperative outcomes. The results demonstrated that QW exhibited significantly higher pCR (56.25 vs. 33.65%; P=0.022) and MPR (81.25 vs. 61.54%; P=0.039) rates than Q3W. Hematological toxicity rates were lower for QW, including neutropenia of all grades (46.88% vs. 70.81%, P=0.0001) and thrombocytopenia of all grades (18.75% vs. 31.73%, P=0.033). Grade ≥3 leukopenia (18.75 vs. 51.92%; P=0.001) and grade ≥3 neutropenia (15.62 vs. 38.46%; P=0.016) were less frequent in QW. In addition, the incidence of acute pneumonia of all grades was also lower (0% vs. 16.35%, P>0.05). However, survival outcomes were comparable between the groups, including 1-year overall survival (QW vs. Q3W, 96.6 vs. 100.0%) and progression-free survival (86.5 vs. 85.6%) rates (P>0.05). In conclusion, QW cisplatin/nab-paclitaxel nCRT achieved superior pCR rates and reduced hematological toxicity compared with Q3W dosing in LA-ESCC, thus suggesting its potential use as a safer and more effective neoadjuvant regimen. The survival benefit remains to be validated with an extended follow-up.