Cetuximab Based Chemotherapy in Recurrent and Metastatic SCC of Esophagus – A Real World Short Case Series from a Tertiary Cancer Care Center

Abstract Background: A significant fraction of esophageal cancers has an increased amount of the epidermal growth factor receptor (EGFR). Prior studies have examined tyrosine kinase inhibitors that target EGFR, but there is currently a lack of information regarding the effects of EGFR-directed monoclonal antibody therapy in these specific cancer types. A retrospective audit was carried out at a single institution, specifically targeting patients who were diagnosed with unresectable or metastatic esophageal squamous cell carcinoma and received cetuximab-based treatment. Patients and Methods: 15 patients who previously had treatment for recurrent or metastatic esophageal squamous cell carcinoma (SCC) were included in the study and retrospectively analyzed. These patients were treated with cetuximab, a monoclonal antibody, based therapy, on a weekly basis. The treatment started with an initial dose of 400 mg/m2, followed by weekly infusions at a dose of 250 mg/m2. Some patients had received cetuximab as a single agent while others received the same with concurrent chemotherapy. Patients were monitored for adverse effects, therapy efficacy, and overall survival. Results: A total of 15 patients (median age of 67 years at the time of analysis) were evaluated. 8th edition AJCC staging system revealed 9 (60%) patients to be having metastatic disease, 5 33.33%) recurrent stage and 1 patient having unresectable disease. The Eastern Cooperative Oncology Group (ECOG) performance score (PS) was I in 4 (26.7%) and II in 11 (73.3%). Majority of patients were males (73.3%) with only 1 patient having multiple comorbidities and the rest having single or none. 5 patients (33.33%) received cetuximab as a single agent, 3 with methotrexate and nab-paclitaxel each, while 2 patients received cetuximab with paclitaxel and paclitaxel plus carboplatin combination each. 9 patients (60%) had received cetuximab or cetuximab based chemotherapy in 1st and 2nd line, while the rest received the same in 3rd and above lines. Median OS was 34 months and 2-year OS rate in the study was 80% while median PFS was 3 months and 6-month PFS rate was 7 % only. 1 patient had complete response; 5 patients (33.33%) had partial response; 9 patients (60%) had disease progression on initial assessment. overall response rate (ORR) as well as disease control rate (DCR) was 40 % at first follow-up as there were no patients with stable disease. Conclusion: Although well tolerated, cetuximab administered as a single agent had minimal clinical activity in patients with metastatic esophageal SCC. Ongoing studies of EGFR inhibitors in combination with other agents may define a role for these agents in the treatment of esophageal. Key words: cetuximab, chemotherapy, advanced esophageal cancer, squamous cell carcinoma