What is the optimal neoadjuvant chemotherapy regimen in resectable oesophageal cancer? (#56)
Multidisciplinary multimodality treatment has been established as the optimal approach for resectable oesophageal and oesophago-gastric junction (OGJ) carcinoma. Although a large number of randomised controlled trials (RCTs) have been conducted, most of these were performed to evaluate the best treatment strategy i.e. neoadjuvant chemotherapy or chemoradiation versus surgery alone or neoadjuvant chemotherapy versus chemoradiation. There is, however, a paucity of randomised studies comparing different chemotherapy regimens and almost none in phase III testing. The recently completed United Kingdom MRC OEO5 study comparing 2 cycles of cisplatin/5-FU with 4 cycles of epirubicin, cisplatin, capecitabine (ECX) was performed to address the necessity of triplet therapy and longer duration of neoadjuvant chemotherapy for operable oesophageal and OGJ adenocarcinoma. However, this disease setting also provides a golden window of opportunity to evaluate novel agents. Pre-treatment biopsies and resected surgical specimens are available to assess pharmacodynamic endpoints of new agents. Comprehensive genome and exome sequencing can be facilitated to look for further drug targets as well as potential predictive biomarkers for new drugs. Furthermore the relative ease to perform repeated oesophageal biopsies may allow correlation with changes in circulating tumour DNA levels. Thus in assessing the optimal neoadjuvant chemotherapy regimens, this provides an invaluable platform of collaborative research efforts across multiple scientific and clinical disciplines.