Cisplatin/Epinephrine Gel Helpful in Esophageal Cancer

Laurie Barclay, MD

November 14, 2002

Nov. 14, 2002 — Endoscopically injected gel of cisplatin and epinephrine may be a useful palliative therapy in exophytic esophageal cancer, according to a report in the November issue of Gastrointestinal Endoscopy. However, the benefits and adverse effects need to be compared with other options such as brachytherapy both alone and in combination.

"The aim of therapy for advanced esophageal cancer is relief of dysphagia with minimal treatment-related morbidity," write Marcus Harbord, PhD, MRCP, from the Royal Free and University College Medical School in London, U.K., and colleagues. "This study assessed the efficacy of endoscopic intratumoral injection of cisplatin/epinephrine gel to relieve obstruction and improve swallowing. The gel is designed to minimize diffusion of active drug away from the tumor injection site."

Of 24 patients with inoperable esophageal cancer and dysphagia caused by exophytic esophageal tumor treated with up to six weekly endoscopic injections of gel, 18 were evaluable. Dysphagia grade improved in four, with improvement lasting 30 to 45 days, and stabilized in 11. Eight patients felt that their ability to swallow improved. Lumen patency improved in six for 29 to 56 days, and stabilized in 10. Exophytic tumor volume decreased in eight, lasting 29 to 114 days.

Although a tracheoesophageal fistula, possibly related to treatment, developed in one patient with intramural and exophytic tumor, other complications were tolerable and self-limited. There was no nephrotoxicity or severe nausea and vomiting typically associated with systemic administration of cisplatin.

"Endoscopic injection of cisplatin/epinephrine gel is a straightforward procedure with standard equipment and techniques, which can provide palliation for patients with exophytic malignant tumors of the esophagus," the authors write. "Assessment of this method in conjunction with other therapeutic options such as brachytherapy is warranted."

Matrix Pharmaceuticals supported this study and employs one of its authors.

Gastrointest Endosc. 2002;56(5):644-651

Reviewed by Gary D. Vogin, MD

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