Perioperative Chemotherapy Improves Survival for Patients with Resectable Esophageal Cancer

According to results from a phase 3 study, perioperative chemotherapy improved survival compared to preoperative chemoradiotherapy among patients with resectable esophageal cancer. 

“The best multimodal approach for resectable locally advanced esophageal adenocarcinoma is unclear,” stated Jens Hoeppner, MD, Bielefeld University, Bielefeld, Germany, and coauthors. “An important question is whether perioperative chemotherapy is preferable to preoperative chemoradiotherapy.”

In this multicenter trial, 438 patients with resectable esophageal cancer were randomized on a 1-to-1 basis to receive either perioperative FLOT (fluorouracil, leucovorin, oxaliplatin, and docetaxel) plus surgery (n = 221) or 41.4 Gy of radiation plus carboplatin and paclitaxel followed by surgical resection (n = 217). The primary end point was 3-year overall survival (OS). Key secondary end points included 3-year progression-free survival (PFS) and safety. 

At a median follow-up of 55 months, 3-year OS was 57.4% in the perioperative chemotherapy arm and 50.7% in the preoperative chemoradiotherapy arm (hazard ratio [HR], 0.70; 95% confidence interval [CI], 0.53 to 0.92; P = .01). The 3-year PFS rates were 51.6% and 35%, respectively (HR, 0.66; 95% CI, 0.51 to 0.85). Grade ≥3 adverse events occurred in 58% of patients in the perioperative chemotherapy arm and 41.8% of patients in the preoperative chemoradiotherapy arm. Serious adverse events were reported by 47.3% and 41.8% of patients, respectively. At a follow-up of 90-days, the mortality rate was 3.1% in the perioperative chemotherapy arm and 5.6% in the preoperative chemoradiotherapy arm. 

“Perioperative chemotherapy with FLOT led to improved survival among patients with resectable esophageal adenocarcinoma as compared with preoperative chemoradiotherapy,” concluded Dr Hoeppner et al. 

Source: 

Hoeppner J, Brunner T, Schmoor C, et al. Perioperative chemotherapy or preoperative chemoradiotherapy in esophageal cancer. N Engl. J Med. Published online: January 22, 2025. doi: 10.1056/NEJMoa2409408