Neo-AEGIS (Neoadjuvant Trial inAdenocarcinoma of the Esophagus and Esophago-Gastric Junction InternationalStudy): Final primary outcome analysis.

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Abstract #295: Maeve Aine Lowery presented the primary outcome analysis of the P3 Neo-AEGIS trial in 362 evaluable pts with locally advanced adenocarcinoma of the esophagus and esophago-gastric junction (AEG). The trial compared the multimodal CROSS (carboplatin/paclitaxel, 41.4 Gyradiation therapy) (n=178) regimen with peri-operative chemotherapies – a modified MAGIC (epirubicin, cisplatin (oxaliplatin), 5-FU (capecitabine))(n=157) regimen (ECF/ECX/EOF/EOX pre-2018) or FLOT (docetaxel, 5-FU,leucovorin, oxaliplatin in 2019/2020) (n=27) regimen

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Results:

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Thought leaders agreed with the investigators that the trial results were not clarifying; many were left unsure as to which option was preferable between preop CROSS chemoradiation and periop MAGIC/FLOT chemo.

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Many commentators found the results unhelpful given that relatively few patients received FLOT perioperative chemo, and that therefore CROSS and FLOT had not had a true head-to-head comparison.

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Some oncologists expressed surprise that the significant response rate associated with CROSS did not translate into a major survival benefit.

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Several oncologists wanted to see the impact of adjuvant immunotherapy in patients with a response.

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Summary:

Thought leaders agreed that the results presented in the Neo-AEGIS trial did not definitively favor either preop CROSS chemoradiation or periop MAGIC/FLOT chemo in locally advanced adenocarcinoma of the esophagus and esophago-gastric junction (AEG). There was particular disappointment that FLOT, considered the superior periop chemo regimen, was not adequately tested against CROSS.

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