An overview of the ESOPEC trial

The Esophageal SOperative Perioperative Evaluation of Chemotherapy (ESOPEC) trial1 is a large randomized controlled trial comparing two established multimodal strategies for resectable esophageal adenocarcinoma: perioperative chemotherapy with Fluorouracil Leucovorin Oxaliplatin Docetaxel (FLOT)2 versus neoadjuvant chemoradiotherapy using the ChemoRadiotherapy for Oesophageal Cancer followed by Surgery Study (CROSS) protocol.3 Conducted in 25 German centers, the trial recruited patients between February 2016 and April 2020, randomizing 438 individuals in a 1:1 fashion. Results were first presented at the 2024 ASCO Annual Meeting, with mature follow-up of 55 months. Patients assigned to FLOT received four cycles before and four after surgery, while those in the CROSS arm underwent weekly carboplatin and paclitaxel with 41.4 Gy of radiotherapy followed by surgery. The primary endpoint was overall survival. The outcomes favored perioperative chemotherapy. Median overall survival was 66 months in the FLOT arm compared with 37 months in the CROSS arm, corresponding to a hazard ratio of 0.70. At 3 years, survival rates were 57.4% versus 50.7%. Progression-free survival also favored FLOT (51.6% vs. 35.0%). R0 resection rates were excellent and similar (~95%), while pathological complete response was slightly higher with FLOT (16.7% vs. 10.1%).