O-OGC04 Peri-operative chemotherapy versus preoperative chemoradiotherapy in treatment of Esophago-gastric junctional adenocarcinomas: A 10-year cohort study

Background Esophago-gastric junctional (EGJ) cancers have been considered recently as distinct tumour entity with characteristic genetic profiles. However, the optimal multimodal therapy of advanced EGJ cancers is still debatable. In this comparative study, we analysed the outcomes of peri-operative chemotherapy (CT) versus pre-operative chemoradiotherapy (CRT) in treatment of advanced EGJ adenocarcinomas. Methods This study included patients with locally advanced but resectable EGJ adenocarcinomas who underwent surgical resection after oncological therapy between 2010 till 2019, at our institution. Follow up till May 2021 was done. The outcomes between CT and CRT groups were retrospectively analysed. The long-term follow up data was obtained via direct contact with the patients during our oncological clinics, cross-checked with our hospital/national patients’ electronic databases. Results 107 patients had EGJ cancers; 90 (84%) patients met our inclusion criteria. Peri-operative chemotherapy was received in 65 (72%) patients. Overall median survival rate was 2.2 years in CRT-group compared to 2.4 years in CT-group (p-value 0.29), with comparable recurrence rates (48% vs 36% respectively). R0-resections were higher in CRT-group (84%) compared to CT-group (71%), yet insignificant p-value 0.197. Preoperative chemoradiotherapy achieved higher complete pathological response (28% vs 6%, p-value 0.009) and negative lymph nodes rates (64% vs 37%, p-value 0.014) compared to CT-group. Short-term outcomes (postoperative complications, morbidity rates and length of hospital stay) were similar across both groups. Conclusions Preoperative chemoradiotherapy was associated with higher complete pathological response and negative lymph nodes rates for EGJ adenocarcinomas compared to peri-operative chemotherapy, without increase in postoperative complications or morbidity rates. However, it wasn’t associated with improved overall or disease-free survival rates. These findings supported the use of CRT in treatment of advanced EGJ adenocarcinomas.

Meta-Analysis of Neoadjuvant Immunotherapy for Patients with Resectable Non-Small Cell Lung Cancer

Purpose: Immunotherapy has created a paradigm shift in the treatment of metastatic non-small cell lung cancer (NSCLC), overcoming the therapeutic plateau previously achieved by systemic chemotherapy. There is growing interest in the utility of immunotherapy for patients with resectable NSCLC in the neoadjuvant setting. The present systematic review and meta-analysis aim to provide an overview of the existing evidence, with a focus on pathological and radiological response, perioperative clinical outcomes, and long-term survival. Methods: A systematic review was conducted using electronic databases from their dates of inception to August 2021. Pooled data on pathological response, radiological response, and perioperative outcomes were meta-analyzed where possible. Results: Eighteen publications from sixteen studies were identified, involving 548 enrolled patients who underwent neoadjuvant immunotherapy, of whom 507 underwent surgery. Pathologically, 52% achieved a major pathological response, 24% a complete pathological response, and 20% reported a complete pathological response of both the primary lesion as well as the sampled lymph nodes. Radiologically, 84% of patients had stable disease or partial response. Mortality within 30 days was 0.6%, and morbidities were reported according to grade and frequency. Conclusion: The present meta-analysis demonstrated that neoadjuvant immunotherapy was feasible and safe based on perioperative clinical data and completion rates of surgery within their intended timeframe. The pathological response after neoadjuvant immunotherapy was superior to historical data for patients who were treated with neoadjuvant chemotherapy alone, whilst surgical and treatment-related adverse events were comparable. The limitations of the study included the heterogenous treatment regimens, lack of long-term follow-up, variations in the reporting of potential prognostic factors, and potential publication bias.

Clinico-epidemiological profile and treatment outcomes in patients with squamous cell carcinoma of the esophagus following docetaxel-based neoadjuvant chemotherapy: experience from a cancer care center in Northeast India

Background Squamous cell carcinoma of the esophagus ranks as the most common cause of cancer incidence and mortality in males and the second most common in females. Surgery alone is associated with poor long-term survival. Neoadjuvant chemoradiation and perioperative chemotherapy without radiation have been tried to improve survival rates. Methods We retrospectively evaluated the neoadjuvant chemotherapy in forty-eight patients with non-metastatic, non-cervical squamous cell carcinoma of the esophagus with a docetaxel-based three-drug regimen to improve complete pathological response rates. Results The median age of presentation was 52 years, with male preponderance. All the patients received three cycles of docetaxel-cisplatin-fluorouracil-based chemotherapy. A complete pathological response to neoadjuvant chemotherapy was seen in 8 patients (17%). Rates of grade 3 hematological toxicities were seen in 12% of patients, with no observed grade 4 toxicity. The most common non-hematological toxicity was grade 3 alopecia (seen in 40%) and grade 2 nausea/vomiting in 8% of patients. At a median follow-up of 26.5 months, 2-year survival for the patients receiving chemotherapy and surgery is 66%. Conclusions Preoperative chemotherapy with a taxane-based triple-drug regimen is a reasonable approach in squamous cell carcinoma of the esophagus, associated with improvement in complete pathological response rates, increases complete resection rates, with manageable toxicity.

Induction chemotherapy with capecitabine and oxaliplatin followed by chemoradiotherapy before surgery in patients with locally advanced rectal cancer (A phase II study)

Background Locally advanced rectal cancer (LARC) has a high incidence of local and distant relapse even after adequate treatment. The emerging role of neoadjuvant induction chemotherapy may allow initial down staging of the primary tumor, less toxicity profile and early treatment of micrometastatic disease followed by chemoradiation, and optimum local control may be attained, with the hope of increased complete response rates Objectives to identify the effect of induction chemotherapy with oxaliplatin and capecitabine (CapeOx) before concurrent chemoradiation in locally advanced rectal cancer in terms of response and toxicity. Primary end point is assessment of complete pathological response rate. Patient and Methods patients with MRI based criteria of high-risk LARC (T4 tumors, tumors within 2 mm of mesorectal fascia, T3 tumors at or below levators and T2-4N+ve tumors) were included. Patients received 12 weeks of induction capecitabine/oxaliplatin followed by concomitant capecitabine and conventional three dimensional conformal radiotherapy. Surgery was done at least 6 weeks after CCRTH. Results Thirty five patients with LARC were recruited during the period from December 2017 till January 2019. Five patients (20.8%) had a pathological complete response (TRG 0) (ypT0N0). Another three patients (12.5%) had near complete pathological response (TRG 1). While unfortunately 29.2% and 37.5% had partial response and poor response respectively. Conclusion Induction chemotherapy could be a promising option for better response rates either clinical or pathological for high risk LARC patients with acceptable toxicity profile.

EP.WE.832A silver lining in the dark COVID cloud: Total neoadjuvant chemotherapy results in complete pathological response in locally advanced distal gastric adenocarcinoma

Aims Perioperative oncological therapies resulting in complete pathological response in diffuse type distal gastric adenocarcinoma are extremely rare. We report the first case of complete pathological regression in a patient with locally advanced diffuse type distal gastric adenocarcinoma (CT3N2M0) who received “total neoadjuvant” chemotherapy with FLOT due to the COVID pandemic. Methods & Results A 73-year-old male patient was diagnosed with cT3N2M0 diffuse type distal gastric adenocarcinoma. He received 4 cycles of neoadjuvant FLOT as planned with immune checkpoint inhibitor Durvlumab and interval PET-CT showed massive reduction in 18F-FDG avidity. However, his surgery was postponed due to the COVID-19 pandemic and given his excellent response to chemotherapy his 4 adjuvant cycles of FLOT were advanced into the preoperative setting. Subsequent PET-CT showed close to zero 18F-FDG uptake and he proceeded to laparoscopic radical subtotal gastrectomy with D2 lymphadenectomy. Histopathology of the resected specimen demonstrated no evidence of residual malignancy, a complete pathological response (TRG1a, ypT0N0 R0). Conclusions Amidst the dark cloud of COVID-19 there was a silver lining for one patient, who due to delayed surgery received total neoadjuvant FLOT (8 cycles). This should generate randomised controlled trials comparing the current standard of care with total neoadjuvant regimens and investigating the utilisation of interval investigations such as CT-PET in monitoring response to preoperative therapy, guiding optimal timing of surgical resection.