PracticeUpdate: Haematology & Oncology

ASCO GI 2017 21

PET scans can informand improve treatment of oesophageal adenocarcinoma P ET scans can be used to assess tumour response to initial chemotherapy and may allow for the tai- loring of further chemotherapy in patients with

induction chemotherapy before chemoradiation and showing that PET scanning after induction chemother- apy to assess response helps guide course corrections quickly to maximise patient benefit from chemother- apy. Though our approach does lengthen a patient’s time before surgery, we found that assessing treatment efficacy with PET scanning can improve efficacy as shown by the ability to achieve a pathologic complete response.” PET scans are covered byMedicare in the US for staging and evaluation of treatment response for oesophageal and gastroesophageal junction cancers. The study showed that PET scans can be used to help guide therapy deci- sions for patients with oesophageal and gastroesophageal junction cancers. “We still need, however,” said Dr Good- man, “to further refine what is the most effective regimen for oesophageal cancer.” In this study, we are adding induction chemotherapy before chemoradiation and showing that PET scanning after induction chemotherapy to assess response helps guide course corrections quickly to maximise patient benefit from chemotherapy. Though our approach does lengthen a patient’s time before surgery, we found that assessing treatment efficacy with PET scanning can improve efficacy as shown by the ability to achieve a pathologic complete response. PracticeUpdate Editorial Team

oesophageal adenocarcinoma. This conclusion was based on initial results of a ran- domised, phase II, federally fundedAlliance for Clinical Trials in Oncology, Cancer and Leukemia Group B trial of PET scan-directed combined modality therapy for oesophageal cancer. KarynA. Goodman, MD, of the University of Colorado School of Medicine, Aurora, explained that, despite aggressive chemoradiotherapy, and surgery, the prog- nosis for patients with oesophageal cancer is poor, with fewer than 50% surviving 5 years after diagnosis. Ways to monitor treatment effectiveness are urgently needed to improve outcomes. PET scans are routinely used to guide therapy decisions in lymphoma but are only beginning to be explored for this purpose in solid tumours. The study is among the first to show the benefit of PET imaging in directing presurgery treatment decisions in oesophageal cancer. Patients with stage 2–3 oesophageal and gastroesoph- ageal junction adenocarcinoma typically receive 5.5 weeks of chemoradiotherapy, followed by surgery. Neo- adjuvant chemoradiation has been shown to improve survival over surgery alone. Several chemotherapy reg- imens are available for use during chemoradiation, yet no reliable method predicts whether a particular chemotherapy will be effective in a given patient. Following an initial PET scan, 257 patients with stage 2–3 oesophageal and gastroesophageal junction ade- nocarcinoma were randomised to one of two induction chemotherapy regimens: modified fluorouracil + leu- covorin and oxaliplatin (FOLFOX-6) or carboplatin/ paclitaxel. A PET scan was repeated after the first few cycles of induction therapy. If the PET scan suggested that the induction chemotherapy had worked, patients con- tinued with the same chemotherapy regimen during chemoradiation. If the PET scan revealed that the induction chemo- therapy regimen was not effective, chemotherapy was changed to the other of the two regimens dur- ing chemoradiation. Overall, 39 of 129 patients who received FOLFOX-6 induction chemotherapy and 49 of 128 who received carboplatin/paclitaxel switched chemotherapy regimens after the PET scan. Among patients who switched to an alternative chemo- therapy after induction therapy, 15.6% ultimately achieved a pathologic complete response. In prior stud- ies, where presurgery chemotherapy was not changed based on a PET scan, the complete pathologic response rate among patients with tumours not responsive to induction chemotherapy as measured by PET scan was only 5%. Prior research suggested a link between pathologic complete response and longer survival in oesophageal cancer. Dr Goodman said, “In this study, we are adding

We still need, however, to further refine what is the most effective regimen for oesophageal cancer.

VOL. 2 • NO. 2 • 2017