Traitement des cancers localisés de l’œsophage et de l’estomac, et cas particulier des tumeurs de la jonction œsogastrique
Seance of wednesday 17 april 2024 (Journée de Cancérologie : cancers oeso-gastriques)
DOI number : 10.26299/eca9-vc09/emem.2024.14.03
Abstract
Esophagogastric cancers are one of the leading causes of cancer deaths worldwide. Surgery constitutes the standard treatment with curative intent for resectable/localized forms.
However, the risk of tumor recurrence after surgery remains high, thus motivating the administration of additional treatment.
For esophageal and gastroesophageal junction cancers, the standard treatment is pre-operative chemo-radiotheray (CRT) according to the CROSS protocol (carboplatin+paclitaxel+41Gy), followed by immunotherapy (nivolumab) post-operatively for one year in case of persistent residual tumor on the surgical specimen. Studies are currently evaluating the benefit of a “watch and wait” strategy for patients with a complete clinical response to CRT.
For gastric and gastroesophageal junction adenocarcinomas, the FLOT perioperative chemotherapy (5FU+oxaliplatin+docetaxel) is the therapeutic standard for all tumors > cT1 and/or N+. Targeted anti-HER2 or anti-angiogenic therapies in combination with perioperative chemotherapy have not improved patient survival. Studies evaluating the benefit of adding immunotherapy to perioperative chemotherapy have shown an improvement in complete histological response, and survival results are pending. For the 10-20% of patients with a tumor harboring a microsatellite instability (MSI) phenotype, preliminary studies evaluating perioperative or preoperative immunotherapy have shown very promising results with 60% of complete histological response.
For these MSI tumors, phase II studies are underway to evaluate the benefit of an organ preservation strategy in case of complete clinical response.
However, the risk of tumor recurrence after surgery remains high, thus motivating the administration of additional treatment.
For esophageal and gastroesophageal junction cancers, the standard treatment is pre-operative chemo-radiotheray (CRT) according to the CROSS protocol (carboplatin+paclitaxel+41Gy), followed by immunotherapy (nivolumab) post-operatively for one year in case of persistent residual tumor on the surgical specimen. Studies are currently evaluating the benefit of a “watch and wait” strategy for patients with a complete clinical response to CRT.
For gastric and gastroesophageal junction adenocarcinomas, the FLOT perioperative chemotherapy (5FU+oxaliplatin+docetaxel) is the therapeutic standard for all tumors > cT1 and/or N+. Targeted anti-HER2 or anti-angiogenic therapies in combination with perioperative chemotherapy have not improved patient survival. Studies evaluating the benefit of adding immunotherapy to perioperative chemotherapy have shown an improvement in complete histological response, and survival results are pending. For the 10-20% of patients with a tumor harboring a microsatellite instability (MSI) phenotype, preliminary studies evaluating perioperative or preoperative immunotherapy have shown very promising results with 60% of complete histological response.
For these MSI tumors, phase II studies are underway to evaluate the benefit of an organ preservation strategy in case of complete clinical response.