The new findings help settle a long-standing debate and will impact disease management, but local and distant failures remain a challenge.
Findings from the phase 3 ESOPEC trial demonstrate an overall survival advantage with a perioperative chemotherapy regimen known as FLOT compared with a neoadjuvant chemoradiation approach, called CROSS, in patients with resectable, locally advanced esophageal adenocarcinoma .American Society of Clinical Oncology annual conference
will have an important effect on the management of patients with resectable esophageal adenocarcinoma and gastroesophageal junction adenocarcinoma, but local and distant failures remain a challenge in this population, explained invited discussant Karyn A. Goodman, MD.
Patients in the FLOT arm received four cycles — one every 2 weeks for 8 weeks —followed by surgery 4-6 weeks later. FLOT cycles were reinitiated 4-6 weeks after surgery and given every 2 weeks for 8 weeks. In the intention-to-treat population, median overall survival was almost twice as long in the FLOT group — 66 months vs 37 months. At 3 years, those who received FLOT had a 30% lower risk of dying , with 57.4% patients alive at that point compared with 50.7% patients in the CROSS arm.Patients receiving FLOT also demonstrated improved progression-free survival , with a median PFS of 38 months vs 16 months. The 3-year PFS was 51.6% with FLOT vs 35.0% with CROSS .
Goodman agreed, noting that, in the wake of ESOPEC, FLOT will likely be adopted as a more standard approach in the United States for patients who are fit. And, for patients who are not candidates for FLOT, CROSS is a reasonable option, she said.Multiple studies, including Goodman's 2021, have demonstrated promising outcomes with combined modalities and adapting therapy based on treatment response.
Further studies are needed to evaluate the synergy of immunotherapy and radiotherapy. The next chapter of the esophageal adenocarcinoma story may feature a"best-of-both-worlds" approach that combines induction chemotherapy, followed by personalized chemoradiation, surgery, and potentially adjuvant immunotherapy, Goodman explained.
Noncolorectal Gi Cancer Otolaryngology ENT Specialty Head And Neck Surgery ENT Speciality Esophageal Adenocarcinoma Oesophageal Adenocarcinoma Malignant Esophageal Neoplasm Esophageal Cancer Cancer Of The Esophagus Malignant Oesophageal Neoplasm Oesophageal Cancer Cancer Of The Oesophagus Biologic Therapy Biologics Esophagus Esophageal Surgery
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