Efficacy of early PET-CT directed switch to carboplatin and paclitaxel based definitive chemoradiotherapy in patients with oesophageal cancer who have a poor early response to induction cisplatin and capecitabine in the UK: a multi-centre randomised controlled phase II trial

Mukherjee, Somnath, Hurt, Christopher N. ORCID: https://orcid.org/0000-0003-1206-8355, Adams, Richard ORCID: https://orcid.org/0000-0003-3915-7243, Bateman, Andrew, Bradley, Kevin M. ORCID: https://orcid.org/0000-0003-1911-3382, Bridges, Sarah ORCID: https://orcid.org/0000-0002-7665-5770, Falk, Stephen, Griffiths, Gareth, Gwynne, Sarah, Jones, Christopher M., Markham, Philip J. ORCID: https://orcid.org/0000-0002-6119-0157, Maughan, Tim, Nixon, Lisette S. ORCID: https://orcid.org/0000-0002-1270-6970, Radhakrishna, Ganesh, Roy, Rajarshi, Schoenbuchner, Simon, Sheikh, Hamid, Spezi, Emiliano ORCID: https://orcid.org/0000-0002-1452-8813, Hawkins, Maria and Crosby, Thomas D.L. 2023. Efficacy of early PET-CT directed switch to carboplatin and paclitaxel based definitive chemoradiotherapy in patients with oesophageal cancer who have a poor early response to induction cisplatin and capecitabine in the UK: a multi-centre randomised controlled phase II trial. EClinicalMedicine 61 , 102059. 10.1016/j.eclinm.2023.102059

PDF - Published Version Available under License Creative Commons Attribution. Download (691kB)

Abstract

Background The utility of early metabolic response assessment to guide selection of the systemic component of definitive chemoradiotherapy (dCRT) for oesophageal cancer is uncertain. Methods In this multi-centre, randomised, open-label, phase II substudy of the radiotherapy dose-escalation SCOPE2 trial we evaluated the role of 18F-Fluorodeoxyglucose positron emission tomography (PET) at day 14 of cycle 1 of three-weekly induction cis/cap (cisplatin (60 mg/m2)/capecitabine (625 mg/m2 days 1–21)) in patients with oesophageal squamous cell carcinoma (OSCC) or adenocarcinoma (OAC). Non-responders, who had a less than 35% reduction in maximum standardised uptake value (SUVmax) from pre-treatment baseline, were randomly assigned to continue cis/cap or switch to car/pac (carboplatin AUC 5/paclitaxel 175 mg/m2) for a further induction cycle, then concurrently with radiotherapy over 25 fractions. Responders continued cis/cap for the duration of treatment. All patients (including responders) were randomised to standard (50Gy) or high (60Gy) dose radiation as part of the main study. Primary endpoint for the substudy was treatment failure-free survival (TFFS) at week 24. The trial was registered with International Standard Randomized Controlled Trial Number 97125464 and ClinicalTrials.gov NCT02741856. Findings This substudy was closed on 1st August 2021 by the Independent Data Monitoring Committee on the grounds of futility and possible harm. To this point from 22nd November 2016, 103 patients from 16 UK centres had participated in the PET-CT substudy; 63 (61.2%; 52/83 OSCC, 11/20 OAC) of whom were non-responders. Of these, 31 were randomised to car/pac and 32 to remain on cis/cap. All patients were followed up until at least 24 weeks, at which point in OSCC both TFFS (25/27 (92.6%) vs 17/25 (68%); p = 0.028) and overall survival (42.5 vs. 20.4 months, adjusted HR 0.36; p = 0.018) favoured cis/cap over car/pac. There was a trend towards worse survival in OSCC + OAC cis/cap responders (33.6 months; 95%CI 23.1-nr) vs. non-responders (42.5 (95%CI 27.0-nr) months; HR = 1.43; 95%CI 0.67–3.08; p = 0.35). Interpretation In OSCC, early metabolic response assessment is not prognostic for TFFS or overall survival and should not be used to personalise systemic therapy in patients receiving dCRT.

Item Type:	Article
Date Type:	Publication
Status:	Published
Schools:	Engineering Medicine Centre for Trials Research (CNTRR) Wales Research Diagnostic Pet Imaging Centre (PETIC)
Publisher:	Elsevier
ISSN:	2589-5370
Funders:	Cancer Research UK
Date of First Compliant Deposit:	28 June 2023
Date of Acceptance:	8 June 2023
Last Modified:	21 Oct 2023 01:07
URI:	https://orca.cardiff.ac.uk/id/eprint/160612

Actions (repository staff only)

Edit Item