O-6-methylguanine-deoxyribonucleic acid methyltransferase methylation enhances response to temozolomide treatment in esophageal cancer
Herein we report a case of a 72-year-old man who had experienced 4-month history of dysphagia with solids and a subsequent 20 pound weight loss. An upper endoscopy revealed a partially obstructing mass located at 33 cm from the incisors, pathology characterized this tumor as moderately differentiated adenocarcinoma of the esophagus. A computed tomography (CT), endoscopic ultrasound and positron emission tomography (PET) were done as part of the staging work-up and the tumor was staged as T4N0M1. The PET scan revealed liver and adrenal metastasis []. The patient received a regimen comprised of epirubicin, cisplatin and 5-fluorouracil (ECF). Patient tolerated ECF therapy fairly well with resolution of his dysphagia; however, he developed lower extremity edema and distal neuropathy, both of which partially resolved once the chemotherapy course was completed. On restaging, he was noted to have a mixed response with progressive liver disease following 2 cycles of chemotherapy by CT and PET scan. He tested positive for MGMT methylation and received TMZ.\nThe study protocol was to evaluate TMZ, an agent commonly used with brain tumors and melanoma. This phase 2 study, IRB approved, targeted individuals with advanced aerodigestive tract cancers whose tumors display methylation of their MGMT promoters. TMZ was given at 225 mg by mouth daily for 7 days followed by 7 days off the therapy with each cycle lasting 28 days. Oncology clinic visits with laboratory testing occurred monthly and scans for staging purposes occurred every 8 weeks. The TMZ was to continue until disease progression occurred or the side-effects of the treatment became intolerable.