The incidence of esophagogastric junction (EGJ) cancer is increasing worldwide. EGJ cancer is defined as the epicenter of adenocarcinoma locating within 5 cm of EGJ according to Siewert classification, or any histology of cancer with epicenter withing 2 cm of EGJ based on the Nishi classification in Japan. The prognosis of EGJ cancer is poor compared to gastric cancer and establishing optimal treatment strategies is important.
Currently, few clinical trials are designed for EGJ cancer only because EGJ cancer is still a less frequently occurring tumor type, especially in Asia. EGJ cancer patients are usually enrolled in clinical trials for esophageal or gastric cancer patients. Thus, we can only try to identify the advance of anti-cancer treatments in EGJ cancer from these trials. Recently, development of multimodal treatments with perioperative strategy has improved the treatment outcomes in locally advanced EGJ and gastric cancer, such as novel chemotherapy combinations, chemoradiation, targeted therapy and immune checkpoint inhibitors. A pivotal trial demonstrated perioperative FLOT4 increased the survival outcomes compared to ECF in Western patients. The initial results from two clinical trials (KEYNOTE 585 and MATTERHORN) show immune checkpoint inhibitor plus chemotherapy is associated with higher pathological complete response rate compared to chemotherapy alone. Biomarker-driven strategy has also been tested in several trials in Her2 amplified and mismatch repair deficient or microsatellite instability-high tumors and the results are also encouraging. In this presentation, I will have a mini-review of the recent advance of perioperative treatment in EGJ cancer. |
