New evolutions for the neoadjuvant and adjuvant treatment of oesophageal cancer

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Published: 5 Jul 2017
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Prof Florian Lordick - University Cancer Center Leipzig, Leipzig, Germany

Prof Lordick talks with ecancer at ESMO GI 2017 about news and new evolutions for neoadjuvant and adjuvant treatment of oesophageal cancer. He discusses the new ESMO guidelines for oesophageal cancer and talks about the need to separate recommendations for oesophageal cancer and adenocarcinoma because of the different biology of the diseases.

This morning I was asked to talk about news and new evolutions in the neoadjuvant treatment of oesophageal cancer. This is really an important topic and what I showed to the audience was the new ESMO guidelines for oesophageal cancer which we published last September. An important aspect is that we have separate recommendations for oesophageal squamous cell cancer and adenocarcinoma. This is important because these are really two different diseases with a different biology. What is going on in adenocarcinoma is that we have interesting ongoing trials comparing neoadjuvant chemoradiation to perioperative chemotherapy because this question is really not solved yet. I showed to the audience ongoing trials including a current trial which is comparing the perioperative FLOT regimen, 5FU, leucovorin, oxaliplatin and docetaxel, compared to the CROSS regimen which is carboplatin, paclitaxel and radiation therapy. This is an ongoing trial which should ultimately solve this question.

For oesophageal squamous cell cancer an interesting question is really if you need surgery or not, if you can go also with definitive radiation, chemoradiation, omitting surgery. There is more data now about salvage surgery which is surgery in case that definitive chemoradiation fails and I showed the current data. This is something that we recommend also in the guidelines but salvage surgery is something that should be done in expert centres because if it is done in less experienced centres then the mortality is really going up. So this was another important aspect.

I also tried to give some insight into new drug regimens, into targeted treatment. I mentioned already that the FLOT regimen is a new regimen which is more important in the perioperative setting of gastric cancer and also oesophageal adenocarcinoma with newly presented data at the last ASCO meeting. There are interesting ongoing trials also on HER2 targeted treatment, putting trastuzumab or also trastuzumab and pertuzumab together with chemotherapy into the preoperative perioperative treatment of oesophageal cancer. It’s quite intriguing and there are several trials in North America but also in Europe and Asia which are investigating on that.

Last but not least I mentioned and showed the value of metabolic imaging, implementing FDG-PET or other imaging biomarkers into the perioperative treatment setting. There are a lot of things ongoing, interesting results coming in to stratify populations according to metabolic or functional response.