Original Article
Question: Which is safer and more effective for treating locally advanced esophagogastric junction and esophagus adenocarcinoma (Neo-AEGIS): trimodality therapy or perioperative chemotherapy?
Design/Method: A phase 3, open-label, randomized clinical trial was conducted in 24 designated centers across multiple European countries. Patients were randomly assigned to receive either perioperative chemotherapy or trimodality therapy in a 1:1 ratio. The trimodality therapy group received preoperative radiotherapy, chemotherapy, and surgery. The perioperative chemotherapy group received chemotherapy before and after surgery. The chemotherapy regimen used varied during the trial, with modifications incorporated during the study period
Setting: Denmark, France, Ireland, Sweden, The United Kingdom
Patients/Study community: 18 years or older patients with adenocarcinoma of the esophagus and esophagogastric junction
Results: The study did not find a significant difference in overall survival or disease-free survival, Pathological responses, margin-free resection rates, and other outcomes between the two treatment approaches. Both approaches had similar operative complications and health-related quality of life outcomes
Commentary: The Neo-AEGIS trial concluded that perioperative chemotherapy demonstrated similar survival outcomes compared to trimodality therapy. Factors such as patient preferences, logistical considerations, and access to adjuvant immunotherapy should be considered in the selection of the treatment approach. The study provides important insights into the management of locally advanced adenocarcinoma of the esophagus and the choice between perioperative chemotherapy and trimodality therapy. It highlights the need for personalized treatment decisions in this complex cancer.
Citation: Reynolds J.V, Preston S.R, O’Neill B, A Lowery M, Baeksgaard L, and et all. Trimodality therapy versus perioperative chemotherapy in the management of locally advanced adenocarcinoma of the esophagus and oesophagogastric junction (Neo-AEGIS): an open-label, randomised, phase 3 trial. Lancet Gastroenterology and Hepatology. 2023; 8: 1015–27
DOI: 10.1016/S2468-1253(23)00243-1
https://www.thelancet.com/journals/langas/article/PIIS2468-1253(23)00243-1/fulltext
Topics: Trimodality Therapy, Perioperative Chemotherapy, Adenocarcinoma, Oesophagus, Oesophagogastric Junction
