Adding Atezolizumab to Modified FOLFOX May Improve Response Rates in Gastroesophageal Junction Cancer

In a phase 1 study, perioperative atezolizumab added to oxaliplatin and 5-fluorouracil (FOLFOX) demonstrated an acceptable safety profile and high tumor regression among patients with localized esophageal and gastroesophageal junction (GEJ) cancer.

Mariela A. Blum Murphy, MD, The University of Texas MD Anderson Cancer Center, Houston, Texas, and coauthors, wrote, “The use of immunotherapy in combination with chemotherapy in the perioperative setting may improve the response rate in patients with localized [esophageal cancer] and GEJ adenocarcinoma.”

This phase 1 study enrolled 20 patients with localized esophageal cancer and GEJ adenocarcinoma between April 2019 and November 2020. Patients received 85 mg/m² oxaliplatin and 2.4g/m² 5-fluorouracil, plus 840 mg atezolizumab on days 1 and 15 of a 28-cycle, for a total of 6 doses. Patients then went on to surgery followed by postoperative 1200mg atezolizumab on day 1 of a 21-cycle for 8 further doses. The primary efficacy objective was pathologic complete response, defined as pathological T0N0.

There were 18 patients who underwent surgery. Of those, 2 achieved the primary objective of pathologic complete response and 2 had near complete pathologic response (<1% viable tumor). The R0 resection rate was 83%.

There were 2 patients who experienced grade 4 treatment-related adverse events, 7 patients who experienced grade 3, and 9 who experienced grade 2. There was no discontinuation of therapy caused by treatment-related events. While 45% of the patients died, there were no treatment-related deaths. The median disease-free survival was 29 months, and 44% of patients had a recurrence.

Dr Blum Murphy et al concluded, “This trial supports further research of stezolizumab for the treatment of patients with [esophageal cancer] and GEJ adenocarcinoma in the perioperative setting.”

Source:

Blum Murphy MA, Nogueras Gonzalez GM, Sewastjanow-Silva M, et al. Phase I trial of perioperative chemotherapy plus immunotherapy in localized esophageal and gastroesophageal adenocarcinoma. Presented at 2023 ASCO Gastrointestinal Cancers Symposium; January 19-21, 2023; San Francisco, CA. Abstract 400.