Preliminary analysis of total neoadjuvant therapy for patients with locally advanced gastric (G) and gastroesophageal (GE) adenocarcinoma.

Authors

Eric Roeland

Eric Roeland

Massachusetts General Hospital Cancer Center, Boston, MA

Eric Roeland , Katie Kanter , Jennifer Yon-Li Wo , Madeleine Fish , Ryan David Nipp , Emily E. Van Seventer , Aparna Raj Parikh , Jill N. Allen , Bruce J. Giantonio , Lawrence Scott Blaszkowsky , Florence Keane , Samuel J. Klempner , David P. Ryan , Hugh G. Auchincloss , Harald Ott , Michael Lanuti , Christopher Morse , John Thomas Mullen , Theodore S. Hong

Organizations

Massachusetts General Hospital Cancer Center, Boston, MA, Massachusetts General Hospital, Boston, MA, Hematology/Oncology, Massachusetts General Hospital, Boston, MA, University of California San Francisco, San Francisco, CA, University of Pennsylvania Abramson Cancer Center, Philadelphia, MA, Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA, The Angeles Clinic and Research Institute, Los Angeles, CA, Division of Thoracic Surgery, Massachusetts General Hospital, Boston, MA

Research Funding

No funding received

Background: Nearly half of patients with G/GE cancer do not receive or complete post-operative chemotherapy and/or chemoradiation (CRT). Total neoadjuvant therapy (TNT) is as an emerging alternate treatment strategy. We have previously reported a 28% pCR with FOLFIRINOX followed by CRT. However, TNT outcomes with FLOT or FOLFOX followed by CRT are lacking. Methods: We retrospectively analyzed patients after resection of locally advanced G/GE after receiving TNT. Patient received neoadjuvant FOLFOX or FLOT x 8 cycles, CRT (G 45 Gy, GE 50.4 Gy) with concurrent chemotherapy (5FU, carboplatin/paclitaxel). The primary aim was to explore TNT completion rates. Secondary aims included pCR and toxicity. We performed descriptive statistics, t-test, chi-squared, and Fisher’s exact tests as appropriate. Results: From 12/2015 to 8/2019, 57.1% (40/70) completed TNT and resection (15.7% active treatment, 15.7% progressive disease, 11% treated elsewhere). Median age was 66.0 (range:27-79) and 73% male. Tumor locations included 57.5% G, 30.0% GE, and 12.5% overlapping. Neoadjuvant chemotherapy included FLOT 22.5% (n = 9) or FOLFOX 77.5% (n = 31). Overall we found a 25% pCR without significant differences between type of neoadjuvant chemotherapy. Conclusions: TNT followed by resection is feasible with acceptable rates of treatment completion and toxicity. Notable limitations include the retrospective analysis, small sample size, and heterogenous treatment. The pCR rate is promising and warrants further prospective study to optimize TNT approaches. None.

FLOT (n = 9)FOLFOX (n = 31)P value
Age, years (mean)62.7 (95% CI 51.4-73.9)63.5 (95% CI 59.3-67.6)0.87
Sex, male (n, %)6 (66.7%)23 (74.2%)0.66
Pre-TNT weight, kg (mean)71.9 (61.7-82.1)82.7 (74.5-90.8)0.20
Total chemotherapy received(%)75.6 (53.8-97.4)75.5 (65.8-85.2)0.99
CRT received (%)98.6 (95.1-102.1)97.6 (92.0-102.7)0.81
Duration of TNT, months (mean)17.2 (14.2-20.2)15.7 (14.2-17.3)0.36
Adverse effects
Weight loss (%)-5.86 (-12.4-0.66)-0.01% (-4.48-4.46)0.21
Neuropathy (n, %)7 (78.8)21 (67.7)0.65
Onycholysis (n, %)2 (22.2)3 (9.6)0.31
R0 resection (n)8 (88.9)30 (96.8)0.34
pCR (n, %)2 (22.2)8 (25.8)1.00

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Abstract Details

Meeting

2020 Gastrointestinal Cancers Symposium

Session Type

Poster Session

Session Title

Poster Session A: Esophageal and Gastric Cancer and Other GI Cancers

Track

Esophageal and Gastric Cancer,Other GI Cancer

Sub Track

Therapeutics

Citation

J Clin Oncol 38, 2020 (suppl 4; abstr 393)

Abstract #

393

Poster Bd #

F4

Abstract Disclosures