Neoadjuvant chemotherapy does not increase perioperative complications in thoracic oesophageal cancer

In the phase 3 JCOG 1109 trial, perioperative complication risk in patients with potentially resectable advanced thoracic oesophageal cancer did not appear to be adversely affected by neoadjuvant chemotherapy, including regimens of docetaxel, cisplatin, and 5-fluorouracil (DCF) and radiation with cisplatin and 5-fluorouracil (CF-RT).

Prof. Kazuo Koyanagi (National Cancer Center, Japan) presented the initial results [1]. The 3-arm JCOG 1109 trial (UMIN000009482) is evaluating the overall survival benefit of DCF and CF-RT compared with standard CF as preoperative therapy in patients with thoracic oesophageal cancer. The primary analysis for the trial is planned for 2023; the current analysis focused on the impact on perioperative complications with the 3 neoadjuvant regimens as the impact of preoperative therapy for oesophageal cancer has not been fully investigated yet.

Patients with stage IB/II/III thoracic oesophageal cancer (n=601) were randomised equally to 1 of 3 arms to receive neoadjuvant chemotherapy prior to transthoracic oesophagectomy with regional lymphadenectomy:

• In the control arm (arm A), patients received cisplatin 80 mg/m² on day 1 plus 5-FU at 800 mg/m² on days 1 to 5 of the 3-week cycle for 2 cycles.
• Patients in arm B received cisplatin 70 mg/m² on day 1, 5-FU 700 mg/m² on days 1 to 5, and docetaxel 70 mg/m² on day 1 every 3 weeks for 3 cycles.
• Arm C received cisplatin 75 mg/m² on day 1 with 5-FU 1,000 mg/m² days 1 through 4 every 4 weeks for 2 cycles in addition to radiation therapy at a total of 41.4 Gy.

The incidence of postoperative complications did not significantly increase with DCF or CF-RT. The rate of grade 3/4 pneumonia was 7.6% in arm A, 5.5% in arm B, and 6.2% in arm C. Grade 3/4 leakage was observed in 3.2% in arm A, 6.6% in arm B, and 7.3% in arm C. The rate of recurrent laryngeal nerve paralysis was 3.2%, 1.6%, and 1.7% in arms A, B, and C, respectively. Postoperative complications of any kind and of grade 2 or higher in severity were observed more in the CF arm (56.2%) compared with the DCF arm (43.7%; P=0.02) and compared with the CF-RT arm (47.8%; P=0.11).

“From these results we could at least say preoperative DCF or CF-RT did not increase the risk of postoperative complications,” Prof. Koyanagi concluded.

1. Koyanagi K, et al. Impact of preoperative therapy for locally advanced thoracic esophageal cancer on the risk of perioperative complications: Results from multicenter phase III trial JCOG 1109. ASCO Gastrointestinal Cancers Symposium 2021, 15-17 January. Abstract 162.

 

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Posted on 12 March 202121 May 2024