Dr. Catenacci on Recent Updates in GEJ and ESCC Cancers

Daniel Catenacci, MD, associate professor of medicine, adult gastrointestinal medical oncologist, director, Gastrointestinal Oncology Program, assistant director of translational research, Comprehensive Cancer Center, University of Chicago Medicine, discusses recent updates in gastroesophageal junction adenocarcinoma (GEJ) and esophageal squamous cell carcinoma (ESCC). 

Many key developments have been made regarding the treatment of patients with GEJ and ESCC, as the paradigms have welcomed novel therapeutic approaches, Catenacci says. In the perioperative setting, several phase 3 studies have examined non-immunotherapy–based therapies to try to determine the optimal approach for patients. Additionally, perioperative chemotherapy triplets in addition to neoadjuvant chemoradiotherapy followed by surgery have emerged in GEJ cancer, Catenacci explains. For ESCC, novel approaches consist of neoadjuvant chemoradiation.

Studies have shown that FLOT chemotherapy, consisting of fluorouracil, leucovorin, oxaliplatin, and docetaxel, is more effective than the MAGIC trial regimen, consisting of epirubicin, cisplatin, and infused fluorouracil, which was considered standard of care for patients with metastatic GEJ cancer. In patients who cannot tolerate FLOT chemotherapy, FOLFOX without docetaxel should be considered, Catenacci explains.

Additionally, results from the phase 3 Neo-AEGIS trial (NCT01726452) suggest noninferiority with the MAGIC trial regimen or the FLOT regimen vs the CROSS regimen, consisting of paclitaxel, carboplatin, and radiation therapy, as neoadjuvant treatment for patients with GEJ or ESCC cancers. 

Ultimately, the FLOT regimen should be considered optimal for patients in terms of overall and disease-free survival. The ongoing phase 3 ESOPEC trial (NCT02509286) is fully accrued and evaluating perioperative FLOT vs neoadjuvant CROSS in patients with GEJ cancer, Catenacci concludes.