ESOPEC研究者深入解析FLOT方案在局部晚期可切除食管腺癌中的优势

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在第20届世界食管疾病大会（ISDE）现场，《肿瘤瞭望消化时讯》对德国比勒费尔德大学的Jens Hoeppner教授进行了专访。Hoeppner教授此前在2024年美国临床肿瘤学会（ASCO）大会上汇报了Ⅲ期ESOPEC研究（NCT02509286）结果，比较了FLOT方案围术期化疗与CROSS方案新辅助放化疗治疗局部晚期可切除食管腺癌的疗效。在此次ISDE大会上，Hoeppner教授进一步深入分析了FLOT方案的临床优势，并探讨了未来结合免疫疗法及“观察等待”策略的应用前景。现将内容整理如下，以飨读者。

肿瘤瞭望消化时讯：试验结果显示FLOT方案优于CROSS方案，您认为这应成为未来局部晚期食管腺癌的标准治疗吗？该方案对于不同亚型或特定患者群体是否有最佳适应证？

Oncology Frontier：The trial results show that the FLOT regimen outperforms the CROSS regimen. Do you believe this should become the standard treatment for locally advanced resectable esophageal adenocarcinoma in the future? Are there specific patient subgroups or cancer types where this regimen is particularly effective?

Jens Hoeppner教授：ESOPEC试验的结果非常明确，因此，我提倡在局部晚期可切除食管腺癌的多模式治疗中，为几乎所有符合适应证的患者使用FLOT方案。此外，在这一适应证范围内，我没有发现任何特定亚组应被排除在这一建议之外。

Prof. Jens Hoeppner: The findings from the ESOPEC trial are unequivocal, leading me to advocate for the use of FLOT in nearly all patients within the indicated group for the multimodal treatment of locally advanced resectable esophageal adenocarcinoma. I do not see any specific subgroup within this indication that would warrant exclusion from this recommendation.

肿瘤瞭望消化时讯：您提到未来可能会结合免疫疗法，如术后使用免疫检查点抑制剂。您如何看待免疫疗法在FLOT或CROSS方案中的潜力，尤其是对于未能完全缓解的患者？

Oncology Frontier：You mentioned the potential for combining immunotherapy, such as post-operative immune checkpoint inhibitors, in future trials. How do you view the role of immunotherapy within the FLOT or CROSS regimen, especially for patients who do not achieve complete remission?

Jens Hoeppner教授：免疫疗法为食管腺癌的多模式治疗开辟出一条有前景的新路径。我们已经启动了几项关于这一领域的研究。ESOPEC试验及其他相关研究结果表明，FLOT方案在减少系统性肿瘤复发方面具有显著效果，且在局部肿瘤控制上也表现良好。尽管超越FLOT的疗效可能具有挑战性，但我相信，在不久的将来，新辅助免疫治疗将成为FLOT手术前治疗可切除食管腺癌的一个有价值的补充。

Prof. Jens Hoeppner: Immunotherapy represents a promising new avenue in the multimodal treatment of esophageal adenocarcinoma. We have initiated several trials investigating this area. The ESOPEC trial, along with other studies, has demonstrated that FLOT is highly effective, particularly in reducing systemic tumor recurrence and exerting local effects on the tumor. While it may be challenging to surpass the efficacy of FLOT, I am confident that, in the near future, neoadjuvant immunotherapy will become a valuable addition to FLOT for treating resectable esophageal adenocarcinoma prior to surgery.

肿瘤瞭望消化时讯：目前关于临床完全缓解后器官保留的研究正在进行中。您认为未来这种“观察等待”策略能在食管癌治疗中发挥作用吗？尤其是在CROSS方案中的应用？

Oncology Frontier：There is ongoing research on organ preservation following clinical complete response. Do you believe that in the future, this "watch and wait" approach could play a role in esophageal cancer treatment, particularly in the application of the CROSS regimen?

Jens Hoeppner教授：我相信，“观察与等待”和主动监测的概念对于术前治疗后达到完全缓解的患者而言，将是不可或缺的，不仅适用于腺癌，也尤其适用于鳞状细胞癌患者。对此我相当确定。然而，我不确定CROSS方案在这种情境下是否具有特殊意义。正如我们在ESOPEC试验中观察到的，对于腺癌，术前使用FLOT治疗后我们实现了至少同等甚至更高的缓解率。因此，我并不认为CROSS方案是一种能够实现更高完全缓解率的特殊预处理方法。尽管如此，整个这一话题对于塑造食管癌未来的治疗算法将至关重要。

Prof. Jens Hoeppner: I am convinced that the concepts of “watch and wait” and active surveillance will be integral for patients achieving complete response after preoperative treatment, not only for adenocarcinoma but also specifically for squamous cell carcinoma. I am quite certain of this. However, I am unsure if the CROSS regimen has specific implications in this context. As we observed in the ESOPEC trial, for adenocarcinoma, we achieved at least equal, if not superior, remission rates after preoperative treatment with FLOT. Thus, I do not see CROSS as a particular pre-treatment method that achieves a higher number of complete responses. Nevertheless, this entire topic will be crucial in shaping future treatment algorithms for esophageal cancer.