Bunting D, et al. - The relationship between neoadjuvant therapy-associated toxicity and clinical outcomes, including survival in patients with potentially curable oesophageal adenocarcinoma, was determined. A common occurrence of neoadjuvant therapy-related toxicity which was demonstrated can have serious consequences including failure to complete chemotherapy cycles, a higher risk of not proceeding to surgical resection and poorer overall survival.

Methods

• Researchers identified a cohort of 286 patients undergoing neoadjuvant therapy followed by surgical resection at a single institution from a prospective database.
• Recording and grading of adverse events from neoadjuvant therapy were performed.
• Two groups of patients were formed in accordance to whether they suffered toxicity or not.
• They compared the groups regarding clinical outcomes including whether patients completed the neoadjuvant course, whether they proceeded to resection and overall survival.

Results

• Sixty-seven of 286 patients experienced neoadjuvant therapy-related toxicity.
• Life-threatening or fatal adverse events were reported in 46 patients.
• Forty-seven percent (47%) patients with toxicity did not complete the chemotherapy course compared to 17% without toxicity, RR 2.7 (95%CI 1.7–4.4), (P < 0.001).
• Failure to proceed to resection was observed in 17.9% of patients suffering toxicity, compared to 7.8% among those without toxicity, RR 2.3 (95%CI 1.2–4.6) P=0.02.
• In patients suffering toxicity (20.7 months), median overall survival was shorter compared to those without toxicity (37.8 months), P=0.008.
• Median overall survival was shorter in patients suffering toxicity (26.2 months) compared with those without toxicity (47.8), P=0.039 when patients failing to proceed to resection were excluded.