The following is a summary of “Individual Participant Data Network Meta-Analysis of Neoadjuvant Chemotherapy or Chemoradiotherapy in Esophageal or Gastroesophageal Junction Carcinoma,” published in the October 2023 issue of Oncology by Faron, et al.

For a study, researchers sought to investigate the optimal neoadjuvant treatment for resectable carcinoma of the thoracic esophagus (TE) or gastroesophageal junction (GEJ), focusing on tumor location and histology subgroups. The study conducted an individual participant data (IPD) network meta-analysis (NMA) using data from randomized controlled trials (RCTs).

Eligible RCTs, closed to accrual before December 31, 2015, that compared at least two of the following strategies were included: upfront surgery (S), chemotherapy followed by surgery (CS), and chemoradiotherapy followed by surgery (CRS). IPD was obtained from investigators. The primary endpoint was overall survival (OS). The IPD-NMA was analyzed using a one-step mixed-effect Cox model adjusted for age, sex, tumor location, and histology.

IPD from 26 out of 35 RCTs (4,985 of 5,807 patients) were included, with 12 comparisons for CS-S, 12 for CRS-S, and four for CRS-CS. Both CS and CRS were associated with increased OS compared to S, with hazard ratios (HR) of 0.86 (0.75 to 0.99, P = .03) and 0.77 (0.68 to 0.87, P < .001), respectively. The NMA comparing CRS versus CS for OS resulted in an HR of 0.90 (0.74 to 1.09, P = .27). Notably, the effect on OS was more significant for GEJ versus TE tumors in the CS versus S comparison (P = .036), and for women in the CRS versus S and CRS versus CS comparisons (P = .003, .012, respectively).

Neoadjuvant chemotherapy and chemoradiotherapy were superior to upfront surgery alone across histology subgroups—however, the magnitude of the treatment effect varied by sex for CRS and tumor location for CS. The study did not identify a substantial OS difference between CS and CRS.

Source: ascopubs.org/doi/full/10.1200/JCO.22.02279