Chemotherapy of Gastrointestinal Malignancies

Beginning with esophageal cancer of both the adeno and squamous variety, it would appear that combined modality therapy is here to stay. Most cancer programs now advocate chemotherapy, usually cisplatin and 5-fluorouracil together with radiation therapy, prior to definitive esophagectomy for localized disease. An exciting advance is the discovery of the activity of paclitaxel in this setting, and it is currently being tested in combination with both cisplatin and carboplatin as well as 5fluorouracil with early indications of success. In this regard, an ongoing protocol at the University of Florida using two to four cycles of carboplatin and paclitaxel followed by continuous infusion 5-fluorouracil and radiation therapy prior to surgery continues to accrue patients and, together with other phase two studies of a similar nature, will help to define the optimal use of paclitaxel in this disease. If its initial promise is confirmed, it is likely that this agent will become an integral component of the new standard of care.