Real-world Evaluation of the Efficacy of Neoadjuvant DCF Over CF in Esophageal Squamous Cell Carcinoma

Abstract

Objective: We aimed to evaluate the efficacy of neoadjuvant docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy over cisplatin and 5-fluorouracil (CF) in patients with surgically resectable advanced esophageal squamous cell carcinoma (ESCC), using real-world data from 85 esophageal centers. Background: JCOG1109 trial, which assessed the superiority of DCF over CF, and the superiority of chemoradiotherapy with CF over CF alone demonstrated the significant survival advantage of neoadjuvant DCF in overall survival (OS) over CF for ESCC. Methods: The ESCC patients who received neoadjuvant CF or DCF at 85 Japanese esophageal centers certified by the Japan Esophageal Society were retrospectively reviewed. After propensity score (PS) matching, the OS and recurrence-free survival were compared between CF and DCF. Results: We initially enrolled 4781 patients. After data cleaning and PS matching using pretreatment variables, 1074 patients for each group were selected for subsequent analysis. There was no significant difference in the incidence of postoperative pneumonia and anastomotic leakage. In the survival analysis, OS was significantly longer in DCF group than CF group (hazard ratio, 0.868; 95% confidence interval, 0.770–0.978; P=0.02), as well as recurrence-free survival (hazard ratio, 0.850; 95% confidence interval, 0.761–0.949; P=0.004). The survival advantage of DCF was not observed in patients with 76 years old or older. Conclusions: Neoadjuvant DCF therapy showed a remarkable survival advantage in surgically resectable ESCC patients, especially in patients who were 75 years old or younger. The current real-world evidence will encourage recommendations for DCF as a standard regimen in neoadjuvant chemotherapy–based treatment strategy for ESCC.

Lymph node metastatic patterns and the development of multidisciplinary treatment for esophageal cancer

“…Subsequently, we conducted a nationwide retrospective study using real-world data from 85 Japanese esophageal centers and proved that neoadjuvant DCF showed a remarkable survival advantage over CF in patients with surgically resectable advanced ESCC. 40 Therefore, neoadjuvant DCF therapy is recognized as a standard treatment.…”

M1 macrophage predicted efficacy of neoadjuvant camrelizumab combined with chemotherapy vs chemotherapy alone for locally advanced ESCC: A pilot study

“…Despite neoadjuvant chemoradiation and surgery, the 3-year survival rate of non-metastatic ESCC is 60%. A Real world, multicenter JCOG1109 study conducted by Satoru Matsuda evaluated neoadjuvant DCF versus CF in ESCC (6). Survival analysis showed that DCF group OS was significantly longer than CF group, but he recurrence free survival rate following resection is 50% only at 2 years in DCF group (6).…”

“…A Real world, multicenter JCOG1109 study conducted by Satoru Matsuda evaluated neoadjuvant DCF versus CF in ESCC (6). Survival analysis showed that DCF group OS was significantly longer than CF group, but he recurrence free survival rate following resection is 50% only at 2 years in DCF group (6). The ESCORT phase 3 trial investigated the efficacy and safety of camrelizumab plus chemotherapy vs placebo plus chemotherapy as a first-line treatment in advanced or metastatic ESCC.…”

Nationwide Validation Study of the Prognostic Significance of Stratification Using Pathological Stage and Response to Neoadjuvant Chemotherapy for Esophageal Squamous Cell Carcinoma

“…6 We have recently validated the efficacy of neoadjuvant DCF using realworld data from Japan. 7 In contrast, NACRT has been adopted as a standard based on the CROSS trial in esophageal societies in western countries. 8 The advantage of perioperative therapy for adenocarcinoma has been proven in the fluorouracil plus leucovorin, oxaliplatin, and docetaxel (FLOT) 4 trial as it exhibited the survival benefit of perioperative 5-FU, oxaliplatin, and docetaxel in adenocarcinoma of the stomach and gastroesophageal junction.…”

“…Subsequently, the JCOG 1109 study proved the survival advantage of neoadjuvant CF plus docetaxel (DCF) in the overall survival, but not the neoadjuvant chemoradiotherapy (NACRT) 6 . We have recently validated the efficacy of neoadjuvant DCF using real-world data from Japan 7 . In contrast, NACRT has been adopted as a standard based on the CROSS trial in esophageal societies in western countries 8 .…”