Radiotherapy or not in locally advanced oesophageal or junctional cancer?

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) [1]. 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.

1. 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.

Copyright ©2023 Medicom Medical Publishers