PET-directed combined modality therapy for gastroesophageal junction cancer: Results of the multicentre prospective MEMORI trial of the German Cancer Consortium (DKTK). (November 2022)

• Record Type: Journal Article
• Authors: Lorenzen, Sylvie; Quante, Michael; Rauscher, Isabel; Slotta-Huspenina, Julia; Weichert, Wilko; Feith, Marcus; Friess, Helmut; Combs, Stefanie E.; Weber, Wolfgang A.; Haller, Bernhard; Angele, Martin; Albertsmeier, Markus; Blankenstein, Christiane; Kasper, Stefan; Schmid, Roland M.; Bassermann, Florian; Schwaiger, Markus; Liffers, Sven-Thorsten; Siveke, Jens T.
• Is Part Of: European journal of cancer. Volume 175(2022)
• Page Start: 99
• Page End: 106
• Publication Date: 2022-11
• Subjects: Gastroesophageal junction adenocarcinoma -- PET response -- Neoadjuvant therapy -- Chemotherapy -- Radiotherapy; Cancer -- Periodicals; Neoplasms -- Periodicals; Cancer -- Périodiques; Cancer; Tumors; Electronic journals; Periodicals; Electronic journals; 616.994
• DOI: 10.1016/j.ejca.2022.07.027
• Languages: English
• ISSNs: 0959-8049

Abstract

Abstract: Background: Positron emission tomography (PET) may differentiate responding and non-responding tumours early in the treatment of locally advanced gastroesophageal junction adenocarcinomas. Early PET non-responders (P-NR) after induction CTX might benefit from changing to chemoradiation (CRT). Methods: Patients underwent baseline 18 F-FDG PET followed by 1 cycle of CTX. PET was repeated at day 14–21 and responders (P-R), defined as ≥35% decrease in SUVmean from baseline, continued with CTX. P-NR switched to CRT (CROSS). Patients underwent surgery 4–6 weeks post-CTX/CRT. The primary objective was an improvement in R0 resection rates in P-NR above a proportion of 70%. Results: In total, 160 patients with resectable gastroesophageal junction adenocarcinomas were prospectively investigated by PET scanning. Eighty-five patients (53%) were excluded. Seventy-five eligible patients were enrolled in the study. Based on PET criteria, 50 (67.6%)/24 (32.4%) were P-R and P-NR, respectively. Resection was performed on 46 responders, including one patient who withdrew the ICF, and 22 non-responders (per-protocol population). R0 resection rates were 95.6% (43/45) for P-R and 86.4% (19/22) for P-NR. No treatment related deaths occurred. With a median follow-up time of 24.5 months, estimated 18 months DFS was 75.4%/64.2% for P-R/P-NR, respectively. The estimated 18 months OS was 95.5% for P-R and 68.2% for P-NR. Conclusion: The primary endpoint of the study to increase the R0 resection rate in metabolic NR was not met. PET response after induction CTX is prognostic for outcome with a prolonged OS and DFS in PET responders. Trial registration: NCT 2014-000860-16. Highlights: MEMORI confirms that early metabolic response is associated with favourable survival. Radiation to neoadjuvant chemotherapy improves tumour response in metabolic non-responders. PET/CT-guided preoperative treatment adaptation seems to be feasible and safe.