In an analysis from the German phase III ESOPEC trial reported in the Journal of Clinical Oncology, Hoeppner et al found that perioperative chemotherapy reduced distant recurrence vs preoperative chemoradiotherapy in patients with nonmetastatic esophageal adenocarcinoma.
The primary analysis of the trial showed that perioperative chemotherapy with fluorouracil/leucovorin/oxaliplatin/docetaxel (FLOT) improved survival vs preoperative chemoradiotherapy with CROSS (41.4 Gy/carboplatin/paclitaxel).
Study Details
In the multicenter trial, 438 patients were randomly assigned to FLOT or CROSS between February 2016 and April 2020. The current analysis included 192 (86.9%) of 221 patients randomly assigned to FLOT and 179 (82.5%) of 217 patients randomly assigned to CROSS who underwent tumor resection.
Key Findings
Median follow-up was 56 months. Overall, 178 patients had disease recurrence, including 81 in the FLOT group and 97 in the CROSS group. A total of 12 patients in the FLOT group and 16 in the CROSS group died without recurrence. Recurrence-free survival at 3 years was 54.5% in the FLOT group vs 39.0% in the CROSS group (hazard ratio [HR] = 0.67, 95% confidence interval [CI] = 0.51–0.89, P = .005).
Locoregional recurrence was identified in 39 patients in the FLOT group vs 32 in the CROSS group, with a 3-year cumulative incidence of 20.2% vs 17.4% (HR = 1.00, 95% CI = 0.62–1.61, P = .99); local recurrence was observed in 19 vs 15 patients (HR = 1.03, 95% CI = 0.51–2.06, P = .94) and regional recurrence in 29 vs 27 (HR = 0.89, 95% CI = 0.52–1.52, P = .68).
Distant recurrence was observed in 64 patients in the FLOT group vs 89 in the CROSS group, with a 3-year cumulative incidence of 31.5% vs 47.2% (HR = 0.59, 95% CI = 0.43–0.82, P = .002).
Death occurred in 80 patients in the FLOT group vs 98 in the CROSS group, with 3-year overall survival of 61.1% vs 55.9% (HR = 0.71, 95% CI = 0.53–0.97, P = .030). Death occurred with recurrence in 65 vs 81 patients, with a 3-year cumulative rate of 32.3% vs 34.9% (HR = 0.70, 95% CI = 0.50–0.98, P = .040). Death occurred without recurrence in 15 vs 17 patients, with a 3-year cumulative rate of 6.6% vs 9.2% (HR = 0.79, 95% CI = 0.38–1.65, P = .53).
The investigators concluded: “Compared with CROSS, perioperative chemotherapy with FLOT improved survival through better systemic tumor control with a reduction in distant tumor recurrences, while locoregional efficacy was similar.”
Jens Hoeppner, MD, of Bielefeld University, Medical School and University Medical Center OWL, Campus Hospital Lippe, Detmold, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: The study was supported by the German Research Foundation. For full disclosures of all study authors, visit ascopubs.org.
