Peri-operative chemotherapy was not significantly inferior to neoadjuvant chemoradiation (CRT) plus surgery in patients with oesophageal or oesophago-gastric junction (OGJ) adenocarcinoma, the final overall survival (OS) analysis of the phase 3 Neo-AEGIS trial showed.
The Neo-AEGIS trial (NCT01726452) aimed to answer the question whether radiotherapy is needed in patients with locally advanced oesophageal or OGJ adenocarcinoma. To investigate this matter, 377 patients were randomised to peri-operative chemotherapy (arm A) or neoadjuvant CRT plus surgery (arm B) . OS was the primary endpoint and Prof. Maeve Lowery (St James’s Hospital, Ireland) presented the final analysis of this outcome.
Although arm B outperformed arm A in terms of the pathological complete response rate (17.3% vs 5.1%; P=0.001) and the major pathological response rate (42% vs 12.1%; P<0.001), the 3-year survival rates were nearly identical for the 2 study groups, with 55% in arm A and 57% in arm B (HR 1.03; 95% CI 0.77–1.38). As for safety, neutropaenia (14.1% vs 2.8%), diarrhoea (10.9% vs 0%), and vomiting (7.6% vs 2.8%) occurred more frequently in arm A than in arm B. Also, no negative effect of radiotherapy was seen with regard to operative complications.
All in all, peri-operative chemotherapy remains non-inferior to neoadjuvant chemoradiation and surgery in this population. “We need to further investigate how the improved response rates with chemoradiation did not extend to a survival advantage for patients who were exposed to this therapy,” said Prof. Lowery. “Recurrence data may provide insights in the mechanism behind these results.” Currently, the standard for patients with no pathologic complete response after CRT and surgery is adjuvant nivolumab.
- Lowery M, et al. Neo-AEGIS (Neoadjuvant Trial in Adenocarcinoma of the Esophagus and Esophago-Gastric Junction International Study): Final primary outcome analysis. Abstract 295, ASCO GI 2023, 19–21 January, San Francisco, CA, USA.
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Table of Contents: ASCO GI 2023
Letter from the Editor
ASCO GI 2023 Highlights Podcast
Oesophageal and Gastric Cancer
Zolbetuximab plus mFOLFOX6 successful in CLDN18.2-positive subgroup of gastric cancer
Regorafenib offers survival benefit for patients with pre-treated gastric cancer
Radiotherapy or not in locally advanced oesophageal or junctional cancer?
Neoadjuvant immunotherapy is safe and efficacious in a phase 2 gastric cancer trial
S-1 adjuvant chemotherapy: 4 or 8 courses in stage 2 gastric cancer?
LATG/LAPG demonstrates excellent long-term efficacy in stage 1 gastric cancer
3-year follow-up data confirms benefits of nivolumab plus chemotherapy
Long-term results for nivolumab plus chemotherapy and nivolumab plus ipilimumab in oesophageal cancer
Promising phase 2 results for HER-Vaxx in gastric cancer
Anal and Colorectal Cancer
IMbrave 151 missed primary endpoint in advanced BTC
Combination botensilimab plus balstilimab demonstrates promising activity in heavily pre-treated MSS CRC
Mutation-based selection to identify patients suitable for panitumumab treatment
Fucoidan associated with quality-of-life benefits in patients with rectal cancer receiving CCRT
ctDNA appears useful in monitoring patients with anal cancer undergoing CRT
SUNLIGHT trial meets primary endpoint in refractory metastatic CRC
Does cell-free DNA influence MRD testing in post-operative colon cancer?
OPERA: surgery may be avoided with adequate therapy in rectal cancer
Can we improve total neoadjuvant therapy for rectal cancer?
Palliative radiation therapy improves hepatic pain in HCC and liver metastasis
Improved survival following postoperative sorafenib plus TACE in HCC
Quality-of-life benefits for tislelizumab in uHCC
Stereotactic body radiation therapy beneficial for patients with locally advanced HCC
SWOG 1815, first-ever phase 3 trial in BTC, fails
Acceptable safety profile and encouraging efficacy of nanvuranlat in BTC
First-line NALIRIFOX superior to standard treatment in mPDAC
Novel approach delivers quality-of-life benefits for patients with pancreatic cancer
Pembrolizumab as first-line in MSI-H mCRC
Drug combo yields longest-ever survival in advanced liver cancer