Clinical Research Of Individualized Therapy In Advanced Esophageal Cancer Based On The Genotype Of ERCC1 C8092A

Background and Objective: Esophageal cancer is a originated in the esophageal mucosa epithelium or gland malignant tumors, is one of the most common malignant tumor in our country, the anhui province is one of the six esophageal cancer high incidence in China.The early symptoms of esophageal cancer is not typical.when patients visited the hospital,most of them in the middle-late stage, most of the patients can not be carried out operation resection.The patients need to take comprehensive treatment of radiotherapy, chemotherapy and other project.Chemotherapy for patients with advanced esophageal cancer, is to improve the quality of life, control the condition, prolong survival time of patients.Cisplatin, due to its single medicine high efficient, low price, in our province is widely used in the treatment of esophageal cancer, but not all patients can benefit from chemotherapy regimens including of cisplatin.A large number of reported that ERCC1 gene polymorphism can be used as one of the indicators of prediction of platinum. The study aimed to explore the role and clinical values of detection of excision repair cross-complementing 1(ERCC1) C8092 A polymorphisms in individualized therapy of advanced esophageal cancer patients.Methods: 125 advanced esophageal cancer patients were enrolled between January 2011 and January 2013 in Anhui Provincial Hospital,Anhui Provincial Cancer Hospital,114 patients were statistically analyzed.Patients were randomly assigned in a 1∶2 ratio to either the standard treatment group or the individualized treatment group before ERCC1 C8092 A assessment.Patients in the standard treatment group received Paclitaxel plus cisplatin.In the individualized treatment group,the ERCC1 C8092 A polymorphisms were detected after DNA PCR amplifications, which extracted from peripheral blood karyocytes before the chemotherapies used. Patients with the AA or AC genotype of ERCC1 C8092 A received Paclitaxel plus cisplatin, and those with CC genotype received Paclitaxel plus 5-fluorouracil. The primary endpoints was response rate.The sencondary endpoints were toxicity of chemotherapy,progression free survival and overall survival. Differences between the groups were statistically analyzed by chi-square test.Survival Differences were analyzed by Kaplan-Meier survival curves.The survival rate analyzed by log-rank test.Results:Follow-up data was up to Jul.1,2014.Response rate was obtained by 12 patients(31.6%) in the standard treatment group and 41 patients(53.9%) in the individualized treatment group(X2=5.095,P=0.024).The rates of grade 3-4 nausea and vomitting(32.9%),anemia(11.8%) were significantly lower in individualized treatment group than in standard treatment group(68.4%,28.9%),(P<0.001,P=0.001).The media progression free survival time was 4.0 months(95%CI was 2.935 months to 5.065 months) in the standard treatment group and 6.0 months(95%CI was 5.176 months to 6.824 months) in the individualized treatment group(P=0.004).The median over survival time was 11.0 months(95%CI was 10.167 months to 11.833 months) in the standard treatment group and 13.0 months(95%CI was 12.067 months to 13.933 months) in the individualized treatment group(P=0.007).Conclusion: The RR,toxicity of chemotherapy,PFS and OS were significantly better in individualized treatment group than in standard treatment group.Detection of ERCC1 gene polymorphism might be performed for advanced esophageal cancer patients to be better individualized, which is worthy of further study.