DCF outperforms standard-of-care for locally advanced oesophageal cancer

Docetaxel plus neoadjuvant cisplatin and 5-fluorouracil (DCF) chemotherapy was superior to CF chemotherapy alone in patients with locally advanced oesophageal cancer, according to the primary analysis of the phase 3 JCOG1109 NExT trial. Moreover, the toxicity profile of the DCF combination regimen was manageable. Therefore, neoadjuvant DCF represents a potential new standard therapy for this Japanese patient population [1].

“In Japan, neoadjuvant chemotherapy with CF is the standard-of-care in locally advanced oesophageal cancer,” Dr Ken Kato (National Cancer Center Hospital, Japan) explained.

The current 3-arm, randomised-controlled, phase 3 JCOG1109 trial (UMIN000009482) compared neoadjuvant DCF with neoadjuvant CF and neoadjuvant CF with radiotherapy (CF-RT). In total, 601 patients were randomised 1:1:1 to one of the 3 treatment arms. Subsequently, all patients received transthoracic oesophagectomy with regional lymphadenectomy. The primary endpoint was overall survival (OS).

The 3-year OS rates were in favour of the DCF arm compared with the CF arm (72.1% vs 62.6%; HR 0.68; one-sided P=0.006; see Figure). There was no statistically significant OS benefit of CF-RT over CF (68.3% vs 62.6%; HR 0.84; P=0.12). These results were consistent across subgroups. Moreover, the median progression-free survival calculation displayed superior outcomes for the DCF arm compared with the CF arm (not reached vs 2.7 years; HR 0.67).

Figure: Overall survival with DCF vs CF in JCOG1109 [1]



The safety profile of DCF was manageable. In patients treated with DCF, certain grade 3–4 adverse events were more common than in the CF arm: neutropenia (85.2% vs 23.4%), hyponatraemia (26.0% vs 6.2%), febrile neutropenia (16.3% vs 1.0%), and appetite loss (21.4% vs 8.3%). Grade 3–4 oesophagitis was more frequently observed in the CF-RT arm (8.9%) than in the CF or DCF arms (both 1.0%). Furthermore, the intensified DCF regimen did not result in an increase in post-operative complications or post-operative mortality compared with the CF regimen.

Dr Kato concluded that the neoadjuvant DCF regimen represents a new standard treatment in patients with locally advanced oesophageal cancer, given the OS benefit of this treatment and its manageable toxicity profile. More data is needed in the Western population.

1. Kato K, et al. A randomized controlled phase 3 trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT Oral Abstract Session A, ASCO GI 2022, 20–22 January.

 

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Posted on 21 March 202221 May 2024