S3415 Can Single Agent Neoadjuvant Chemotherapy Cure Locally Invasive Esophageal Adenocarcinoma?

Abstract

INTRODUCTION: Esophageal cancer is the 6th most common cause of cancer related deaths with 500,000 new cases yearly worldwide. Despite advances in the management modalities of locally advanced esophageal cancer, the 5-years survival rate remains below 50%. Surgical resection has been the mainstay of therapy in locally advanced esophageal cancer. Neoadjuvant therapies in combination with surgery have previously shown an improvement in survival in these patients. CASE DESCRIPTION/METHODS: Patient is a 63-year-old female with history of type 2 DM, HTN, and long-term Barrett's esophagus (BE) who was recently diagnosed with esophageal adenocarcinoma (EA). She underwent EGD in April 2019 which was negative for malignancy. Another EGD in July 2019 showed a 2 cm distal esophageal mass, found to be T2 EA, and A 6 cm area of BE. Subsequently, she was referred to CT surgery and plan was made to manage her with neoadjuvant chemotherapy and radiation therapy (XRT) before evaluating for surgical candidacy. She underwent 8 cycles of chemotherapy with 5-FU and XRT which were completed in October 2019. Due to multiple comorbidities, she was eventually deemed not a good candidate for surgery. EGD radiofrequency ablation and/or mucosal resection were chosen as definitive therapy. She has since undergone several follow-up EGDs. EGD done in November 2019 showed focal EA. Follow-up EGD in February 2020 revealed BE with low-grade dysplasia without signs of malignancy. EUS did show a stage T2N1 EA. She underwent radiofrequency ablation at that time for BE. Follow up EGD in April 2020 showed recurrent BE without masses or nodules. Repeat radiofrequency ablation was performed. She is being closely followed by a multidisciplinary team for recurrence. DISCUSSION: Locally advanced esophageal cancer patients that are not surgical candidates have previously been managed with two agent chemotherapy. To our knowledge, single agent chemotherapy has not been previously studied. In our case, we saw resolution of the mass with biopsy in February 2020 negative for malignancy. Considering the previous positive biopsy in November 2019 and the subsequent EUS finding of T2N1, the EGD in February 2020 might have missed the EA. Moreover, neoadjuvant chemotherapy shrinks the cancer to make it surgically resectable which could have made it hard to take a good biopsy specimen. As data on single agent chemotherapy is scant, studies need to be conducted to evaluate the prospect of single agent chemotherapy as a definitive therapy for esophageal cancer.