ESOPEC trial (ASCO plenary)

Prof Dr Jeroen Dekervel from UZ Leuven (Belgium) and Prof Dr Florian Lordick from the University of Leipzig (Germany)  discuss the ESOPEC trial.

The ESOPEC trial focused on patients with adenocarcinoma of the oesophagus or esophagogastric junction, as defined by the UICC (TNM7) classification, within 5 cm of the esophagogastric junction extending into the oesophagus and compared FLOT perioperative chemotherapy (four cycles of 5-FU, leucovorin, oxaliplatin, and docetaxel before and after surgery) with neoadjuvant chemoradiotherapy (weekly paclitaxel, carboplatin, and 41.4 Gy radiation). Eligible patients had locally advanced disease (T2-T4 or nodal positive), were operable, and had good performance status and organ function. The primary endpoint was OS, and secondary endpoints included PFS, morbidity, mortality, postoperative pathological stage, and QoL.

With a median follow-up of 55 months, the trial demonstrated that FLOT was superior to CROSS, with a significant improvement in three-year OS (HR 0.70).

While the ESOPEC trial suggests that FLOT is the superior regimen, ongoing developments, such as the integration of immunotherapy, will continue to influence treatment recommendations. Special situations, such as comorbidities or specific deficiencies, may still justify neoadjuvant chemoradiotherapy. It is important to remain open-minded and adaptable as new data emerges.

In summary, the ESOPEC trial makes a significant contribution to our understanding of the optimal treatment for oesophagal adenocarcinoma, shifting the paradigm towards perioperative chemotherapy with FLOT compared to chemoradiation with CROSS.