Trimodality Therapy Leads to QOL Improvement in Esophageal Cancer

“Early interventions such as nutritional support and prehabilitation should be studied to improve QOL and OS,” wrote the study authors.

Among patients with esophageal cancer who were treated with induction chemotherapy, chemoradiation (CRT), and surgery, quality of life (QOL) appeared to be affected most by CRT, according to results from the phase 2 CALGB 80803 trial (NCT01333033), presented at the 2024 Gastrointestinal Cancer Symposium.

Between timepoint 1 (T1) and T2, global QOL and symptoms worsened in 14 of 25 domains. They continued to worsen in T3 for 19 domains, T4 for 17 domains, and T5 for 6 domains.

“Early interventions such as nutritional support and prehabilitation should be studied to improve QOL and OS,” wrote the study authors.

Patients with a primary tumor of size 3/4 or N-positive esophageal adenocarcinoma were randomly assigned between November 2011 and May 2015 after receiving a baseline PET scan. Patients then went on to receive induction chemotherapy which included either folinic acid, fluorouracil, and oxaliplatin (FOLFOX6) on days 1, 15, and 29, or carboplatin/paclitaxel on days 1, 8, 22, and 29. PET scans were completed between days 36 and 42. If patients had a 35% or more decrease in maximum standard uptake value (SUV max), they were to continue initial chemotherapy and concurrent radiotherapy at 50.4 Gy in 28 fractions. If they had a decrease of less than 35%, they were to cross over to the other arm. Six weeks after radiotherapy was finished, surgical resection was performed.

Clinicians were to collect QOL domains and symptoms at 5 different time points, T1 was induction chemotherapy, T2 was CRT, T3 was surgery, T4 was collected 3 months after surgery, and T5 was collected 3 months after T4. Questionnaires were also sent out to determine QOL at baseline with overall survival which was tested with Cox regression.

A total of 257 patients were registered to the study, of whom 189 enrolled on the QOL sub study. Of these patients 110 were PET responders, and 79 were PET nonresponders. Additionally, 97.9% of patients received CRT and 83.6% had surgery.

Starting at T1, patients who received FOLFOX experienced improvement in the ability to eat and gastrointestinal symptoms between T3 and T4, as well as talking at T5. From T1 patients who received induction chemotherapy had improvement in neuropathy at T2, T3, and T4, and coughing in T5. For patients who had patient reported outcome scores, there was no significant difference between PET responders and PET nonresponders.

Investigators also evaluated OS by baseline QOL EORTC scores. QOL domains and symptoms were found to be associated with OS. These included appetite loss (HR, 1.012; 95% CI, 1.005-1.019; P = .0005), pain (HR, 1.014; 95% CI, 1.006-1.022; P = .0003), global health score/QOL (HR, 1.017; 95% CI, 1.008-1.027; P = .0002), and role functioning (HR, 0.989; 95% CI, 0.982-0.996; P = .0013).

Reference

Goodman K, Dueck A, Fruth B, et al. Quality of life (QOL) for patients with esophageal cancer receiving trimodality therapy with induction chemotherapy, chemoradiation, and surgery: results from CALGB 80803 (Alliance). Presented at the 2024 Gastrointestinal Cancers Symposium; San Francisco, CA; January 18-20, 2024. Poster 283.