Oxaliplatin/capecitabine or carboplatin/paclitaxel-based preoperative chemoradiation for resectable oesophageal adenocarcinoma (NeoSCOPE): Long-term results of a randomised controlled trial

S. Mukherjee, C. Hurt*, G. Radhakrishna, S. Gwynne, A. Bateman, S. Gollins, M.A. Hawkins, J. Canham, H.I. Grabsch, S. Falk, R.A. Sharma, R. Ray, R. Roy, C. Cox, N. Maynard, L. Nixon, D.J. Sebag-Montefiore, T. Maughan, G.O. Griffiths, T.D.L. Crosby

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

4 Citations (Web of Science)

Abstract

Aim: This is the first randomised study to evaluate toxicity and survival outcomes of two neoadjuvant chemoradiotherapy (CRT) regimens for patients with localised oesophageal adenocarcinoma (OAC) or gastro-oesophageal junction (GOJ) adenocarcinoma. The initial results showed comparable toxicity between regimens and pathological complete response (pCR) rate favouring CarPacRT. Herein, we report survival, progression patterns, and long-term toxicity after a median follow-up of 40.7 months.Methods: NeoSCOPE was an open-label, UK multicentre, randomised, phase II trial. Eightyfive patients with resectable OAC or GOJ adenocarcinoma, >= cT3 and/or >= cN1 (TNM v7), suitable for neoadjuvant CRT, were recruited between October 2013 and February 2015.Patients were randomised to OxCapRT (oxaliplatin 85 mg/m(2) on Days 1, 15, and 29; capecitabine 625 mg/m(2) orally twice daily on days of radiotherapy [RT]) or CarPacRT (carboplatin AUC2; paclitaxel 50 mg/m(2) on Days 1, 8, 15, 22, and 29). RT dose was 45 Gy/25 fractions/5 weeks. Both arms received induction chemotherapy (two cycles oxaliplatin 130 mg/m(2) on Day 1, capecitabine 625 mg/m(2) orally twice daily on Days 1-21) before CRT. Surgery was performed 6-8 weeks after CRT.The primary end-point was pCR. Secondary end-points were toxicity, progression-free survival (PFS), overall survival (OS), and patterns of progression.Results: Eighty-five patients were recruited from 17 UK centres. The median OS was 41.7 months (95% confidence interval [CI] 19.6 to not reached) in the OxCapRT arm and was not reached in the CarPacRT arm (multivariable hazard ratio [HR] = 0.48, 95% CIs: 0.24-0.95, P = 0.035). The median PFS was 32.6 months (95% CIs: 17.1 to not reached) in the OxCapRT arm and was not reached in the CarPacRT arm (multivariable HR = 0.54, 95% CIs: 0.29-1.01, P = 0.053). In both arms, the distant progression was twice as common as locoregional progression.Conclusions: OS and PFS favoured neoadjuvant CarPacRT over OxCapRT. Distant was more common than locoregional progression; therefore, priority should be given to optimising the systemic treatment component. (C) 2021 The Author(s). Published by Elsevier Ltd.
Original languageEnglish
Pages (from-to)153-161
Number of pages9
JournalEuropean Journal of Cancer
Volume153
DOIs
Publication statusPublished - 1 Aug 2021

Keywords

  • Randomised controlled trial
  • Neoadjuvant chemoradiotherapy
  • Surgery
  • Survival
  • Oesophageal cancer
  • NEOADJUVANT CHEMORADIOTHERAPY
  • PERIOPERATIVE CHEMOTHERAPY
  • SURGERY
  • CANCER

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