Chemotherapy before and after surgery benefits some oesophageal cancer patients

For patients with locally advanced oesophageal adenocarcinoma that can be treated with surgery, chemotherapy treatment before and after surgery improved survival when compared to chemoradiotherapy before surgery. This is according to data from the phase 3 ESOPEC clinical trial, which was presented at the 2024 ASCO Annual Meeting.

The trial compared two treatment strategies for locally advanced oesophageal adenocarcinoma that could be treated with surgery. A total of 221 participants were randomised to the FLOT protocol (treatment with chemotherapy before and after surgery) arm and 217 participants were randomised to the CROSS protocol (treatment with chemoradiotherapy before surgery) arm. The majority (89 per cent) of the participants were men, who are more commonly affected by this cancer.

For all study participants, 403 started some form of treatment and 371 went on to receive surgery (191 in the FLOT arm and 180 in the CROSS arm).

In the 90 days after surgery, 4.3 per cent of the participants had died (3.2 per cent in the FLOT arm and 5.6 per cent in the CROSS arm), and after a median follow-up of 55 months, 218 participants had died (97 in the FLOT arm and 121 in the CROSS arm).

Median overall survival was 66 months (five years, six months) in the FLOT arm and 37 months (three years, one month) in the CROSS arm.

At three years, participants who received FLOT had a 30 per cent lower risk of dying than those who received CROSS. The three-year overall survival rates were 57 per cent for the FLOT arm and 51 per cent in the CROSS arm.

Of the 359 participants whose tumour regression status was known, a pathological complete response was achieved in 35 patients in the FLOT arm and 24 in the CROSS arm.

Researchers will now study whether surgery can be avoided in patients with cancers that have a complete pathological response to treatment with the FLOT or CROSS protocols and show no growth during active surveillance.