Neoadjuvant Therapies Confer Survival Benefit in Esophageal, GEJ Cancer

Neoadjuvant chemotherapy or chemoradiotherapy improves outcomes in patients with esophageal or gastroesophageal junction (GEJ) cancer, according to a meta-analysis published in the Journal of Clinical Oncology.

Researchers found that both neoadjuvant therapies prolonged overall survival (OS) and disease-free survival (DFS), when compared to surgery alone, in this patient group.

The meta-analysis included 26 randomized clinical trials designed to compare at least 2 of these treatment strategies: surgery, chemotherapy followed by surgery, and chemoradiotherapy followed by surgery. The trials included 4,985 patients, 81% of whom were men.

In an adjusted analysis, OS was significantly improved with chemotherapy plus surgery (hazard ratio [HR], 0.86; 95% CI, 0.75-0.99; P =.03) or chemoradiotherapy plus surgery (HR, 0.77; 95% CI, 0.68-0.87; P <.001), compared with surgery alone.

There was no significant difference in OS between patients who received chemotherapy plus surgery and those who received chemoradiotherapy plus surgery (HR, 0.90; 95% CI, 0.74-1.09; P =.27). However, the researchers noted, there was a limited number of patients in the direct comparison of these approaches.

The researchers also observed a significant improvement in DFS with chemotherapy plus surgery (HR, 0.79; 95% CI, 0.69-0.91; P =.001) or chemoradiotherapy plus surgery (HR, 0.78; 95% CI, 0.68-0.88; P <.001), compared with surgery alone.  

There was no significant difference in DFS between patients who received chemotherapy plus surgery and those who received chemoradiotherapy plus surgery (HR, 0.98; 95% CI, 0.80-1.21; P =.85).

“This network meta-analysis confirms a benefit for either chemotherapy or chemoradiotherapy in the neoadjuvant setting for esophageal and GEJ carcinomas,” Andrew H. Ko, MD, associate editor of the journal, wrote in a comment.

“The incremental benefit conferred by the addition of radiation to chemotherapy in this context appears to be quite modest, a decision that can potentially be informed by specific clinical features.”

Disclosures: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Cancer Therapy Advisor