Chemotherapy for Esophageal Cancer

Chemotherapy (chemo) is treatment with certain kinds of drugs that destroy cancer cells. The drugs travel through the bloodstream to reach cancer cells in most parts of the body.

Chemo might be used by itself to treat esophagus (esophageal) cancer, or it might be given along with radiation therapy (called chemoradiation) or with other types of medicines.

When is chemotherapy used for esophageal cancer?

Chemo may be used at different times during treatment for esophageal cancer.

• Along with radiation (chemoradiation): For some cancers, chemo might be given along with radiation to try to shrink the cancer. Surgery and/or immunotherapy may follow in some cases.
• After surgery (adjuvant chemotherapy): Adjuvant chemo might be given to kill any cancer cells that might have been left behind or have spread but are too small to see on imaging tests. If these cells were allowed to grow, they could form new tumors in other places in the body.
• Before and after surgery (perioperative chemotherapy): In people with adenocarcinoma of the esophagus, chemo is often given both before and after surgery, usually along with immunotherapy.
• Chemo for advanced cancers: For cancers that have spread to other organs, such as the liver, chemo can also be used to help shrink tumors and relieve symptoms. Although it is not likely to cure the cancer, it often helps people live longer.

Which chemo drugs used to treat esophageal cancer?

Chemo drugs that might be used to treat esophageal cancer include:

• 5-fluorouracil (5-FU)
• Capecitabine
• Oxaliplatin
• Cisplatin or carboplatin
• Docetaxel or paclitaxel
• Irinotecan
• Trifluridine–tipiracil

Most often, combinations of 2 or 3 chemo drugs are used, if a person can tolerate them.

For adenocarcinomas of the esophagus, chemo is typically given along with an immunotherapy drug.

For some esophageal cancers, chemo may be used along with a targeted drug such as trastuzumab (Herceptin and other brand names) or ramucirumab (Cyramza).

The choice of which chemo drugs to use and how long a person gets them depends on several factors, such as the type of esophageal cancer, the reason and timing of when chemo is being given, how well the cancer responds to it, and what side effects a person has.

How is chemotherapy given?

Chemo drugs for esophageal cancer are typically given into a vein (IV), either as an injection over a few minutes or as an infusion over a longer period. Some drugs you take by mouth. All these drugs enter your bloodstream and reach most areas of your body. These drugs can be given in a doctor’s office, infusion center, or in a hospital.

Often, a slightly larger and sturdier IV called a central venous catheter (CVC), central venous access device (CVAD), or central line is used to give chemo. It can also be used to put other medicines, blood products, nutrients, or fluids right into your blood, and to take out blood for testing. Once in place, a CVC can often stay in for as long as you’re getting treatment, so you won’t need to be stuck with a needle each time to get chemo or have your blood drawn.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 to 4 weeks long. The schedule varies depending on the drugs used. Some drugs might be given only on the first day of the cycle, while others might be given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant or neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced esophageal cancer depends on how well it’s working and what side effects you are having.

Possible side effects of chemotherapy

Chemo drugs can cause side effects. These depend on the type and dose of drugs given, and the length of treatment. Some of the most common side effects of chemo include:

• Nausea and vomiting
• Loss of appetite
• Hair loss
• Mouth sores
• Diarrhea or constipation

Chemo can also affect the blood-forming cells of the bone marrow, which can lead to:

• Increased chance of infection (from having too few white blood cells)
• Easy bleeding or bruising (from having too few blood platelets)
• Fatigue (from having too few red blood cells and other reasons)

Other side effects are also possible. Some of these are more common with certain chemo drugs. For example:

Most chemo side effects tend to go away after treatment. Some, such as hand and foot numbness, may last for a long time. There are often ways to lessen these side effects. For example, you can be given drugs to help prevent or reduce nausea and vomiting.

Be sure to ask any questions you have about side effects with your cancer care team. Report any side effects or changes you notice while getting chemo right away so that they can be treated promptly. In some cases, the doses of the chemo drugs may need to be reduced, or treatment may need to be delayed or stopped to prevent the side effects from getting worse.