PET Scans Help Providers Tailor Therapy for Esophageal Cancer Patients, Increasing Survival

Researchers find that the use of PET scans at baseline and after induction therapy can help them tailor chemotherapy regimens in esophageal cancer patients, increasing survival.

Esophageal cancer is estimated to account for 1% of all cancers diagnosed in the United States, according to the American Cancer Society.

Although many of these patients go on to die from this disease, new research presented at the 2018 American Society of Clinical Oncology (ASCO) Annual Meeting, suggests that PET scans could help them live longer lives.

Researchers from the University of Colorado Cancer Center presented survival results from a recent trial, dubbed CALGB 80303, which found that with the help of PET scans, providers could identify esophageal cancer patients who were not responsive to induction therapy. Knowing this led them to switch these patients over to a new chemotherapy regimen (FOLFOX) during chemoradiation, resulting in a median overall survival of 27 months, a 9-month improvement compared with past studies which used non-responders.

Responder patients who switched over to FOLFOX showed a 55% 4-year survival, the best outcome ever reported for esophageal cancer patients, according to an official press release.

Typically, patients receive 5.5 weeks of chemoradiation, followed up by surgery.

“Esophageal cancer patients undergo treatment to shrink tumors before surgery. We wanted to see if PET scan could help us personalize the best pre-operative treatment,” Karyn Goodman, MD, MS, Grohne Chair of Clinical Oncology at University of Colorado Cancer Center, explained in a recent statement.

For the trial, a total of 257 patients with adenocarcinoma of the esophagus or gastroesophageal junction were given a PET scan when diagnosed as well as 6 weeks post-induction therapy with FOLFOX or carboplatin/taxol. If the patients showed a good response by PET, they remained on the regimen during chemoradiation, if they did not respond favorably, they were switched to a different regimen. After chemoradiation, the participants underwent surgery.

Previous to this study, this same research team found that switching chemotherapy regimen for non-responders resulted in a higher rate of pathologic complete response and reported it at ASCO 2017; now, at this year’s meeting, the researchers present survival rates from the same population.

They report that the group of patients who were responsive to induction therapy had a higher median survival rate (46 months) compared with non-responders (27 months).

“This makes sense,” Dr Goodman said. “Again, these are patients who benefitted from induction chemotherapy, whether with FOLFOX or with carboplatin/taxol. We would expect them to live longer than patients who did not respond.”

The researchers were unable to determine the median overall survival for those who were responsive to the FOLFOX regimen during induction therapy, and thus, remained on the regimen during chemoradiation, because 55% of these patients were still alive when researchers analyzed the data. The researchers stress that the big takeaway from their analysis was really what was seen when they switched non-responders over to another regimen during chemoradiation.

“Twenty-seven months median overall survival is much better than we have seen in previous studies for patients who do not respond to induction chemotherapy,” Dr. Goodman stressed. “We show that using PET scan at baseline and then again after induction chemotherapy can help to determine who should stick with the chemotherapy used during induction and who should switch to the other regimen during chemoradiation.”

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Feature Picture Source: Todd Huffman / flickr / Creative Commons.