Adjuvant chemotherapy following neoadjuvant chemotherapy plus surgery for patients with gastroesophageal cancer—is there room for improvement?
Menée à partir de données du registre national américain des cancers portant sur 10 086 patients atteints d'un adénocarcinome gastro-œsophagien de stade T1N1-3M0 ou T2-4N0-3M0 diagnostiqué entre 2006 et 2013, cette étude évalue, du point de vue de l'amélioration de la survie globale, l'intérêt d'une chimiothérapie après un traitement comportant une chimioradiothérapie puis une résection chirurgicale
Optimal multimodality treatment followed by surgical resection results in cure for less than half of patients with operable adenocarcinoma of the lower esophagus or gastroesophageal junction. This is true whether the adjunctive therapy is neoadjuvant chemotherapy, perioperative chemotherapy, or neoadjuvant chemoradiotherapy. Therefore, it is reasonable to question whether additional treatment beyond current standards of care might increase the proportion of patients cured. In this issue of JAMA Oncology, Mokdad and colleagues,1 in a propensity score–matched analysis based on a large National Cancer Database cohort, examine the effects of adjuvant chemotherapy following chemoradiotherapy and surgery for resectable gastroesophageal adenocarcinoma. They found that patients treated with adjuvant chemotherapy had improved overall survival compared with those who did not receive adjuvant treatment (median overall survival, 40 vs 34 months; hazard ratio, 0.79; 95% CI, 0.72-0.88; P < .001). Based on these findings, a randomized clinical trial of adjuvant chemotherapy vs observation following neoadjuvant chemoradiotherapy and surgical resection is proposed to provide a definitive answer to this question.
JAMA Oncology , commentaire en libre accès, 2016