Oesophageal cancer treatment study: reasons for hope

The successful phase III CheckMate 577 trial used adjuvant immunotherapy; a promising treatment for patients with recurrent oesophageal or upper gastric cancer.

Succesful new immunotherapy for recurrent oesophageal cancer

The New England Journal of Medicine reports on the successful use of adjuvant immunotherapy as a new and promising treatment option for patients with recurrent oesophageal or upper gastric cancer. These results are from the phase III CheckMate 577 trial, and the new therapy has received European approval.

Researchers at the University Medical Center of the Johannes Gutenberg University Mainz (in short, University Medical Centre Mainz. German name: Universitätsmedizin der Johannes Gutenberg-Universität Mainz), in collaboration with international cooperation partners, have succeeded in discovering a new and promising treatment option for patients with recurrent oesophageal or upper gastric cancer. If the current standard treatment, consisting of chemotherapy, radiation therapy and surgery, is supplemented with post-operative immunotherapy, the risk of recurrence is reduced and patients have a higher chance of living longer without cancer recurrence. 

Conventional treatment for oesophageal cancer

It is not uncommon for patients with oesophageal or upper gastric cancer to have a recurrence shortly after intensive treatment of the first tumour. Until now, the standard treatment for patients with locally advanced oesophageal or upper gastric cancer consisted of a combination of so-called neoadjuvant, i.e. preparatory, chemotherapy and radiation therapy, followed by surgical removal of the tumour. However, this therapy combination has not succeeded in reducing the risk of recurrence for a longer period of time.

Adjuvant immunotherapy should ensure longer survival

With the aim of reducing the likelihood of a recurrence and thus offering the affected patients the chance of a longer survival, scientists from the University Medical Center Mainz participated in the international, randomised, double-blind, placebo-controlled phase III study "Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer", in short Checkmate 577.

In this study, Prof. Dr. Markus Möhler, head of the gastroenterological-oncological outpatient clinic of the University Medical Centre Mainz, and colleagues evaluated a postoperative, so-called adjuvant therapy in patients for whom no pathologically-complete remission was achieved and the disease was still diagnostically detectable. For this, they chose an immuno-oncological approach: a drug that specifically supports the immune system after tumour resection and activates it to fight off cancer cells that are still present but not visible, thereby preventing metastases from forming. The active substance is an immune checkpoint inhibitor, the monoclonal anti-PD-1 antibody nivolumab.

This adjuvant immunotherapy had a positive effect on the study participants: on average, they lived 22 months longer and thus twice as long without a recurrence of the tumour as those who only received a placebo. The scientists at the University Medical Centre Mainz and the cooperating research teams have thus succeeded for the first time in achieving a long-term disease-free survival advantage in patients with advanced oesophageal cancer treated with various therapies.

Original publication:
Ronan J. Kelly, Jaffer A. Ajani, Jaroslaw Kuzdzal et.al: Adjuvant Nivolumab in Resected Esophageal or Gastroesophageal Junction Cancer. The New England Journal of Medicine, 1 April, 2021.