Downstaging and Histological Effects Might Be Reliable Predictors of the Efficacy of DOC+CDDP+5-FU (DCF) as Neoadjuvant Therapy for Stage III or Borderline Resectable Esophageal Cancer: a Single Institute Experience

Kobayashi, Kazuma; Kanetaka, Kengo; Yoneda, Akira; Kobayashi, Shinichiro; Maruya, Yasuhiro; Isagawa, Yuriko; Yoshimoto, Tomoko; Migita, K.; Kawaguchi, Yuta; Kuba, Sayaka; Morita, Michi; Okada, Satoru; Kosaka, Taiichiro; Yamaguchi, Shun; Inoue, Yusuke; Adachi, Tomohiko; Hidaka, Masaaki; Torashima, Yasuhiro; Ito, Shinichiro; Takatsuki, Mitsuhisa; Eguchi, Susumu

doi:10.1007/s12029-020-00431-x

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…The clinical downstaging rate was 83.3%, significantly higher than that of neoadjuvant chemotherapy (30%) (39). The pathologic downstaging rate was 74.0%, better than that of neoadjuvant chemotherapy (26.1%-63.3%) (40)(41)(42)(43)(44)(45)(46)(47)(48). For lung cancer, several large-sample phase 3 trials have extended the neoadjuvant treatment cycle to 3-4 cycles, such as KEYNOTE-671, CheckMate 816, IMpower030, and AEGEAN.…”

Section: Discussionmentioning

confidence: 99%

Neoadjuvant Sintilimab Plus Chemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

Tian

et al. 2022

Front. Oncol.

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BackgroundNeoadjuvant chemotherapy (nCT) and chemoradiotherapy (nCRT) are the standard treatments in patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). Adding PD-1 inhibitor to the chemotherapy has shown significant clinical benefits in first-line treatment of advanced ESCC. This study evaluated the efficacy and safety of neoadjuvant sintilimab plus chemotherapy in patients with resectable locally advanced ESCC.MethodsThe clinical data of 96 patients with resectable locally advanced ESCC, treated with sintilimab plus chemotherapy followed by esophagectomy, were reviewed. The pathologic complete response (pCR) rate, major pathological response (MPR) rate, R0 resection rate, tumor downstaging, survival, and safety were retrospectively analyzed.ResultsPatients were between the ages of 43 and 78 years (interquartile range [IQR], 60–69 years). Forty (41.7%) were diagnosed with stage II ESCC, 52 (54.2%) with stage III, and 4 (4.2%) with stage IVA. Sixty-seven (69.8%) were male, and 84 (87.5%) patients had an ECOG PS of ≤1. Forty-eight (50.0%) patients received 3–4 cycles of the neoadjuvant treatment. Twenty-nine (30.2%) patients obtained pCR, and MPR was achieved in 60 (62.5%) patients. The R0 resection rate was 99%. Eighty (83.3%) patients achieved clinical downstaging, and 71 (74.0%) achieved pathological downstaging. The median follow-up was 8.9 months, and 1-year DFS rate was 95.2% (95% CI, 88.8%–100%). Grade 3–4 TRAEs occurred in 12 (12.5%) patients, and the incidence of grade 3–4 surgical complications was 2.1%. No deaths were reported.ConclusionThese real-world data revealed that neoadjuvant sintilimab plus chemotherapy could provide encouraging pCR with good tolerability for resectable locally advanced ESCC, and this regimen warrants further exploration in prospective clinical studies.

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Section: Discussionmentioning

confidence: 99%

Neoadjuvant Sintilimab Plus Chemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

Tian

et al. 2022

Front. Oncol.

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“…Based on these results, the Guidelines for the Diagnosis and Treatment of Carcinoma of the Esophagus have been revised, and DCF will be used as one of the standard treatments for cStage II/III esophageal cancer in the future. Although DCF has a high response rate [4] and prolongs the OS and PFS [5] , treatment-related adverse events frequently occur [6] . Severe side effects, particularly hematological and gastrointestinal toxicities, were noted.…”

Section: Introductionmentioning

confidence: 99%

Prevention of the Adverse Effects of Neoadjuvant Chemotherapy for Esophageal Cancer: Role of Nutritional Management in Different Neoadjuvant Chemotherapy Regimens

Onishi

Tajika

Tanaka

et al. 2023

Preprint

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Based on the results of the JCOG1109 trial, docetaxel + cisplatin + 5-fluorouracil (DCF) may be a standard neoadjuvant chemotherapy (NAC), in addition to the conventional 5-fluorouracil and cisplatin (FP) therapy. We examined whether the nutritional therapy should be modified when a different NAC is used based on the changes in body composition. The study included 215 patients with advanced esophageal cancer who underwent surgery after receiving NAC at our hospital between 2013 and 2019, and those who underwent abdominal computed tomography before and after NAC. The skeletal muscle mass index (SMI) was calculated using the following formula: total skeletal muscle mass at the third lumbar level/height2. The visceral and subcutaneous fat masses were assessed at the umbilical level. The lower 25% of men and women were defined as the low visceral fat and low subcutaneous fat groups, respectively. The DCF group was significantly younger (p < 0.01), had higher proportion of men (p = 0.03), and had higher proportion of patients with cStage III disease (p < 0.01) compared with the FP group. The body composition changes were not significantly different in terms of percentage changes in SMI and visceral fat mass. Multivariate analysis showed that cStage III disease and a shift to low visceral fat were prognostic factors, whereas differences in NAC were not. Although no significant difference was found in the body composition before and after NAC, aggressive nutritional management is recommended during NAC, especially because a shift to a low visceral fat affects the patient’s prognosis.

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Prognostic impact of shift to low visceral fat mass after neoadjuvant chemotherapy in patients with esophageal cancer

Onishi,

Tajika,

Tanaka

et al. 2024

Cancer Reports

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BackgroundBased on the JCOG1109 trial, it is suggested that the combination of docetaxel, cisplatin, and 5‐fluorouracil (DCF) could potentially become a standard neoadjuvant chemotherapy regimen, alongside the conventional 5‐fluorouracil and cisplatin (CF) therapy, for esophageal cancer. However, there are few reports on the impact of body composition changes associated with neoadjuvant chemotherapy on prognosis.AimOur study aimed to explore the effect of different neoadjuvant chemotherapy regimens on body composition during treatment and the impacts of body composition changes on their prognosis.Methods and resultsThis is a retrospective study of 215 patients with advanced thoracic esophageal cancer who had surgery after neoadjuvant chemotherapy from 2013 to 2019. Computed tomography scans were performed before and after neoadjuvant chemotherapy to assess body composition. Skeletal muscle mass index (SMI) was calculated by dividing total skeletal muscle mass at the 3rd lumbar level by the square of height, while visceral and subcutaneous fat masses were measured at the level of umbilicus. Patients in the lowest 25% of both sexes were classified into the low visceral fat and low subcutaneous fat groups, respectively. Of the patients enrolled, 178 were male and 37 were female. Among them, 91 had clinical Stage II disease, and 124 had clinical Stage III disease. Additionally, 146 patients received neoadjuvant chemotherapy CF, and 69 received neoadjuvant chemotherapy DCF. Comparing the DCF and CF groups, the DCF group consisted of significantly younger patients (p < .01), a higher proportion of males (p = .03), and a greater number of clinical Stage III cases (p < .01). However, although percent change in SMI and visceral fat mass was not significantly different between two regimens, percent change in subcutaneous fat mass was significant in the DCF group. The major prognostic factors for patients undergoing surgery after neoadjuvant chemotherapy for thoracic esophageal cancer were clinical Stage III, transition to low visceral fat, and response rating (SD/PD), while the specific neoadjuvant chemotherapy regimen did not significantly influence the outcomes.ConclusionThis study suggests that prevention of the shift to low visceral fat throughout the neoadjuvant chemotherapy process should improve patient outcomes.

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Downstaging and Histological Effects Might Be Reliable Predictors of the Efficacy of DOC+CDDP+5-FU (DCF) as Neoadjuvant Therapy for Stage III or Borderline Resectable Esophageal Cancer: a Single Institute Experience

Cited by 5 publications

References 19 publications

Neoadjuvant Sintilimab Plus Chemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

Neoadjuvant Sintilimab Plus Chemotherapy in Resectable Locally Advanced Esophageal Squamous Cell Carcinoma

Prevention of the Adverse Effects of Neoadjuvant Chemotherapy for Esophageal Cancer: Role of Nutritional Management in Different Neoadjuvant Chemotherapy Regimens

Prognostic impact of shift to low visceral fat mass after neoadjuvant chemotherapy in patients with esophageal cancer

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