ESOPEC
ESOPEC pitted the two standard ways of treating operable oesophageal adenocarcinoma against each other, chemotherapy before and after surgery or chemoradiotherapy before it, and found that the chemotherapy approach helped people live longer.
Overview
ESOPEC was a German multicentre phase 3 trial of 438 patients with resectable adenocarcinoma of the oesophagus or gastro-oesophageal junction, randomised to perioperative FLOT (four cycles before and four after surgery) or to the CROSS regimen of carboplatin and paclitaxel with 41.4 Gy of radiotherapy followed by surgery. The primary endpoint was overall survival.
Perioperative FLOT lengthened overall survival compared with neoadjuvant chemoradiotherapy, with a similar rate of complete resection and postoperative complications. The result, reported in 2024 and published in 2025, tipped guidelines towards perioperative chemotherapy for adenocarcinoma of the oesophagus, and the trials adding immunotherapy to FLOT build on it.
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