Trimodality therapy reduces the risk of death but increases the risk of adverse events, when compared with definitive chemoradiation, in older patients with locally advanced esophageal cancer, according to research published in JNCI Cancer Spectrum.

The study showed that patients who received trimodality therapy had a lower risk of all-cause and cancer-specific mortality at 5 years, but they had a higher risk of functional adverse events at 1 year.

The study included 1901 adults diagnosed with locally advanced esophageal cancer between 2004 and 2017. Patients had adenocarcinoma (n=1240) or squamous cell carcinoma (n=661). The median age at baseline was 72 years in both groups (overall range, 68-75 years).


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Among patients with adenocarcinoma, the 5-year cumulative incidence of overall mortality was 73.4% with trimodality therapy and 83.8% with definitive chemoradiation (risk ratio [RR], 0.88; 95% CI, 0.82-0.95). The 5-year cumulative incidence of cancer-specific mortality was 61.2% and 71.0%, respectively (RR, 0.86; 95% CI, 0.77-0.98).

Among patients with squamous cell carcinoma, the 5-year cumulative incidence of overall mortality was 62.6% with trimodality therapy and 72.3% with definitive chemoradiation (RR, 0.87; 95% CI, 0.70-1.01). The 5-year cumulative incidence of cancer-specific mortality was 51.0% and 58.1%, respectively (RR, 0.88; 95% CI, 0.68-1.07).

The researchers acknowledged that “the mortality reduction reported may be overestimated, as patients with tumor biology favorable for resection may be more likely to be offered surgery.”

The data also showed that the 1-year incidence of functional adverse events was higher with trimodality therapy for both adenocarcinomas and squamous cell carcinomas. 

Among patients with adenocarcinoma, the 1-year cumulative incidence of functional adverse events was 57.9% with trimodality therapy and 41.3% with definitive chemoradiation (RR, 1.40; 95% CI, 1.22-1.65). Among patients with squamous cell carcinoma, the 1-year cumulative incidence of functional adverse events was 46.8% with trimodality therapy and 38.5% with definitive chemoradiation (RR, 1.21; 95% CI, 1.00-1.49).

“[T]he findings of our observational study merit consideration by older patients and their providers when discussing care plans and can enhance shared decision making and optimize patient outcomes,” the researchers concluded.

Disclosures: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Gaber CE, Shaheen NJ, Edwards JK, et al. Trimodality therapy vs definitive chemoradiation in older adults with locally advanced esophageal cancer. JNCI Cancer Spectr. Published online October 7, 2022. doi:10.1093/jncics/pkac069

This article originally appeared on Cancer Therapy Advisor