Improving Treatment for Patients With Gastroesophageal Cancer

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, 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.

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