The combination of 5-fluorouracil, leukovorin, etoposide, and cisplatin (FLEP) in patients with metastatic esophageal cancer. A single-institution experience.

BACKGROUND

A retrospective analysis was carried out on the efficacy and toxicity of the combination of 5-fluorouracil, leucovorin, etoposide and cisplatin (FLEP) in patients with metastatic esophageal cancer treated at our institution.

METHODS

Patients received intravenous 5-fluorouracil 500 mg/m2, leucovorin 300 mg/m2, etoposide 100 mg/m2 and cisplatin 30 mg/m2, on days 1 to 3. Courses were repeated every 4 weeks until progression or up to a maximum of 6 courses. Patients were evaluated for response after every three courses using computed tomography.

RESULTS

Eighteen patients received a total of 76 courses (median 4, range 1-6). The median time to progression was 9.2 months and the overall response rate was 22% (one complete response i.e. 5%, and three partial responses i.e. 17%). Seven patients (39%) had stable disease, while another 7 progressed during therapy. The median survival for all patients was 10.2 months. The most common hematological toxicities were leukocytopenia and neutropenia grade 3, which occurred in two patients (11%) each, while grade 3 and 4 infection was seen in one patient each (5%). Anemia grade 3 occurred in 2 patients (11%). Nonhematological toxicities consisted of nausea/vomiting grade 3 in 3 (17%), diarrhea grade 3 in one (5%) and mucositis grade 3 in 3 patients (17%).

CONCLUSIONS

We conclude that the FLEP combination is a safe and active regimen for patients with metastatic esophageal cancer.