CROSS versus modified MAGIC or FLOT in oesophageal and gastro-oesophageal junction adenocarcinoma
Mené en Europe entre 2013 et 2020 sur 362 patients atteints d'un adénocarcinome de l'oesophage ou de la jonction oeso-gastrique (durée médiane de suivi : 38,8 mois ; 90 % d'hommes), cet essai randomisé multicentrique de phase III compare l'efficacité, du point de vue de la survie globale, d'une thérapie trimodale (radiothérapie préopératoire avec carboplatine plus paclitaxel, protocole CROSS) et d'une chimiothérapie périopératoire (protocole MAGIC modifié ou FLOT)
The optimal management of locally advanced oesophageal and gastro-oesophageal junction adenocarcinoma has remained a subject of ongoing debate for several years. In The Lancet Gastroenterology & Hepatology, John V Reynolds and colleagues report the results of the phase 3 Neo-AEGIS trial comparing perioperative chemotherapy regimens (epirubicin plus cisplatin or oxaliplatin plus fluorouracil or capecitabine [a modified MAGIC regimen] before 2018 and fluorouracil, leucovorin, oxaliplatin, and docetaxel [FLOT] subsequently) with trimodality therapy (preoperative radiotherapy with carboplatin plus paclitaxel [CROSS regimen]) in 362 patients with oesophageal or gastro-oesophageal junction adenocarcinoma. With a 3-year overall survival rate of 55% (95% CI 47–62) with perioperative chemotherapy versus 57% (49–64) with trimodality therapy (hazard ratio 1·03 [95% CI 0·77–1·38]; log-rank p=0·82), the Neo-AEGIS trial benchmarks the outcomes after contemporary high-quality multimodality treatment. 1 Other outcomes, including disease-free survival, recurrence patterns, and operative results, also showed no significant differences between the CROSS and MAGIC or FLOT regimens. With FLOT being administered to just 15% of patients in the perioperative chemotherapy group, the comparison between CROSS versus FLOT awaits resolution through the forthcoming results of the ESOPEC trial (NCT02509286). Until then, Neo-AEGIS strongly suggests clinical equipoise. This proposition is supported by a recent individual participant data network meta-analysis of four previous randomised trials (including a total of 497 patients) on neoadjuvant chemoradiotherapy versus chemotherapy (hazard ratio for overall survival 0·90 [95% CI 0·74–1·09]).