The role of adjuvant platinum‐based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery. Issue 7 (2nd March 2017)

• Record Type: Journal Article
• Authors: Saunders, John H.; Bowman, Christopher R.; Reece‐Smith, Alex M.; Pang, Vincent; Dorrington, Matthew S.; Mumtaz, Errum; Soomro, Irshad; Kaye, Philip; Madhusudan, Srinivasan; Parsons, Simon L.
• Is Part Of: Journal of surgical oncology. Volume 115:Issue 7(2017)
• Page Start: 821
• Page End: 829
• Publication Date: 2017-03-02
• Subjects: chemo‐resistance -- chemotherapy -- drug toxicity -- esophagogastric cancer -- tumor regression; Cancer -- Surgery -- Periodicals; Neoplasms -- Periodicals; 616
• DOI: 10.1002/jso.24601
• Languages: English
• ISSNs: 0022-4790

Abstract

Abstract : Background and Objectives: For patients with operable esophagogastric cancer, peri‐operative chemotherapy confers a significant overall survival benefit compared to surgery alone, however only 30‐40% of patients demonstrate histopathological response. It is unclear whether those with no neoadjuvant chemotherapy response should go onto receive adjuvant chemotherapy, as no further benefit may be conferred. Methods: Esophagogastric cancers were prospectively captured with associated histopathological tumor regression grades following neoadjuvant chemotherapy. This cohort was then interrogated for clinico‐pathological and survival outcomes. Results: Following neoadjuvant chemotherapy and surgery, patients with chemotherapy responsive cancers, who were administered adjuvant chemotherapy gained a significant overall survival benefit. Multivariate Cox analysis, demonstrated a final adjusted hazard ratio for adjuvant therapy of 0.509; (95%CI 0.28‐0.93); P = 0.028. In contrast, patients with non‐responsive tumors, who underwent adjuvant chemotherapy, did not show any survival benefit. Chemotherapy toxicity was prevalent and contributed to only half of patients receiving adjuvant chemotherapy. Conclusions: These results suggest the benefit of the adjuvant portion of chemotherapy is limited to those who demonstrate a histopathological response to neoadjuvant chemotherapy. The administration of the adjuvant portion of chemotherapy to patients without a response to neoadjuvant chemotherapy may not provide any survival benefit, while potentially causing increased morbidity.