Taxotere, Cisplatin and Irinotecan (CPT-11) for Esophagogastric Cancer

Inclusion Criteria: Histologically confirmed, incurable esophageal or gastric carcinoma (carcinoma = adenocarcinoma or squamous cell carcinoma) Measurable disease > 1cm (longest diameter) by spiral CT scan or > 2cm by other radiographic technique. Lesions must be measurable in at least one dimension. Bone lesions, ascites and effusions are not measurable. Irradiated lesions are not measurable yet lesions arising in previously irradiated fields are measurable. Age 18+ years. ECOG performance status 0 or 1. Life expectancy greater than 12 weeks. Adequate bone marrow function. Adequate renal function: creatinine equal to or less than 1.5 mg/dl. SGOT less than 2.5 x institutional upper limit of normal if alkaline phosphatase is within institutional upper limit of normal. Alkaline phosphatase less than 4.0 x upper limit of normal if SGOT is within institutional upper limit of normal. For patients with both SGOT and alkaline phosphatase elevations, SGOT must be less than 1.5 x institutional upper limit of normal and alkaline phosphatase must be less 2.5 x institutional upper limit of normal. For patients with liver metastases, however, SGOT may be < 3.0 x institutional upper limit of normal and alkaline phosphatase may be < 5.0 x institutional upper limit of normal as long as the total bilirubin is within the institutional upper limit of normal. Exclusion Criteria: No prior chemotherapy (except as part of pre- or post-operative therapy, completed > 1 year prior to start date of this protocol). Patients who have received prior pelvic radiation therapy are ineligible. Other prior radiation therapy, however, is permitted, provided at least 4 weeks have elapsed since completion of this therapy and the initiation of this protocol. No myocardial infarction in the past six months. No major surgery in the past three weeks. No uncontrolled serious medical or psychiatric illness. No uncontrolled diarrhea. Patients with a peripheral neuropathy > grade 1 will be excluded. Women of childbearing potential must have a negative pregnancy test. Men and women of childbearing potential must use adequate contraception. No clinically apparent central nervous system metastases or carcinomatous meningitis. No other active malignancy other than non-melanoma skin cancer or in-situ cervical carcinoma. A resected cancer (other than in-situ carcinoma) must have demonstrated no evidence of recurrence for at least 3 years. Patients with history of severe hypersensitivity to irinotecan, cisplatin, taxotere or drugs formulated with polysorbate 80 must be excluded.