Interpretation of the main updates of the NCCN clinical practice guidelines for esophageal and esophagogastric junction cancer (version 1.2023)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHANG Ping , SU Quanbing ,  WANG Jun

The First Ward of Thoracic Radiotherapy, The Fourth Hospital of Hebei Medical University, Shijiazhuang, 050000, P. R. China;

Corresponding author：

WANG Jun, Email: wangjunzr@163.com

Keywords：

Esophageal cancer; esophagogastric junction cancer; NCCN guideline; interpretation of the main updatets

DOI：

10.7507/1007-4848.202304045

Video：

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Upper gastrointestinal tract cancers originating in the esophagus or esophagogastric junction constitute a major global health problem. On February 28, 2023, National Comprehensive Cancer Network (NCCN) released the clinical practice guidelines for esophageal and esophagogastric junction cancer (version 1.2023). This article will interpret the main updates related to the treatment and follow-up in this version compared to the version 5.2022, in order to provide the Chinese clinicians a better basis and reference for the diagnosis and treatment of the diseases.

Citation： ZHANG Ping, SU Quanbing, WANG Jun. Interpretation of the main updates of the NCCN clinical practice guidelines for esophageal and esophagogastric junction cancer (version 1.2023). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2023, 30(7): 939-944. doi: 10.7507/1007-4848.202304045 Copy

1.	郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2.	段纪俊, 严亚琼, 杨念念, 等. 中国恶性肿瘤发病与死亡的国际比较分析. 中国医学前沿杂志(电子版), 2016, 8(7): 17-23.
3.	National Comprehensive Cancer Network. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 1.2023). URL: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
4.	Hofstetter W. Treatment of clinical T2N0M0 esophageal cancer. Ann Surg Oncol, 2014, 21(12): 3713-3714.
5.	Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: A systematic review and meta-analysis. Gastrointest Endosc, 2012, 75(2): 242-253.
6.	Keswani RN, Early DS, Edmundowicz SA, et al. Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer. Gastrointest Endosc, 2009, 69(7): 1210-1217.
7.	FDA approves selpercatinib for locally advanced or metastatic RET fusion-positive solid tumors. URL: https://prn.to/3dFC8Bz. Accessed on 2022-09-21.
8.	Salama AKS, Li S, Macrae ER, et al. Dabrafenib and Trametinib in patients with tumors with BRAFV600E mutations: Results of the NCI-MATCH trial subprotocol H. J Clin Oncol, 2020, 38(33): 3895-3904.
9.	Subbiah V, Wolf J, Konda B, et al. Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): A phase 1/2, open-label, basket trial. Lancet Oncol, 2022, 23(10): 1261-1273.
10.	Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
11.	Sun JM, Shen L, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): A randomised, placebo-controlled, phase 3 study. Lancet, 2021, 398(10302): 759-771.
12.	FDA grants accelerated approval to pembrolizumab for first tissue/site agnostic indication. URL: https://www.fda.gov/drugs. Accessed on 2020-02-21.
13.	Conroy T, Galais MP, Raoul JL, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): Final results of a randomised, phase 2/3 trial. Lancet Oncol, 2014, 15(3): 305-314.
14.	Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): A randomised, phase 2/3 trial. Lancet, 2019, 393(10184): 1948-1957.
15.	Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med, 1998, 339(27): 1979-1984.
16.	王镇, 秦建军, 李勇, 等. 从外科视角看可切除颈段食管癌的治疗. 中国胸心血管外科临床杂志, 2020, 27(10): 1217-1222.
17.	Ohno K, Nasu M, Matsui H, et al. Real-world treatment patterns and outcomes in Japanese patients with cervical esophageal cancer. Esophagus, 2022, 19(4): 576-585.
18.	Liu Y, Huang N, Xu W, et al. A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases. Front Surg, 2022, 9: 1001488.
19.	van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
20.	Alderson D, Cunningham D, Nankivell M, et al. Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma (UK MRC OE05): An open-label, randomised phase 3 trial. Lancet Oncol, 2017, 18(9): 1249-1260.
21.	Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: A phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
22.	Kofoed SC, Muhic A, Baeksgaard L, et al. Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction. Scand J Surg, 2012, 101(1): 26-31.
23.	Al-Batran SE, Hartmann JT, Probst S, et al. Phase Ⅲ trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: A study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol, 2008, 26(9): 1435-1442.
24.	Al-Batran SE, Pauligk C, Homann N, et al. The feasibility of triple-drug chemotherapy combination in older adult patients with oesophagogastric cancer: A randomised trial of the Arbeitsgemeinschaft Internistische Onkologie (FLOT65+). Eur J Cancer, 2013, 49(4): 835-842.
25.	Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): A phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.
26.	Soularue É, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: A retrospective study. Bull Cancer, 2015, 102(4): 324-331.
27.	Chung HC, Bang YJ, S Fuchs C, et al. First-line pembrolizumab/placebo plus trastuzumab and chemotherapy in HER2-positive advanced gastric cancer: KEYNOTE-811. Future Oncol, 2021, 17(5): 491-501.
28.	Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase Ⅲ study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V325 Study Group. J Clin Oncol, 2006, 24(31): 4991-4997.
29.	Oppedijk V, van der Gaast A, van Lanschot JJ, et al. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol, 2014, 32(5): 385-391.
30.	Dorth JA, Pura JA, Palta M, et al. Patterns of recurrence after trimodality therapy for esophageal cancer. Cancer, 2014, 120(14): 2099-2105.
31.	Sudo K, Xiao L, Wadhwa R, et al. Importance of surveillance and success of salvage strategies after definitive chemoradiation in patients with esophageal cancer. J Clin Oncol, 2014, 32(30): 3400-3405.
32.	Taketa T, Sudo K, Correa AM, et al. Post-chemoradiation surgical pathology stage can customize the surveillance strategy in patients with esophageal adenocarcinoma. J Natl Compr Canc Netw, 2014, 12(8): 1139-1144.

1. 郑荣寿, 孙可欣, 张思维, 等. 2015年中国恶性肿瘤流行情况分析. 中华肿瘤杂志, 2019, 41(1): 19-28.
2. 段纪俊, 严亚琼, 杨念念, 等. 中国恶性肿瘤发病与死亡的国际比较分析. 中国医学前沿杂志(电子版), 2016, 8(7): 17-23.
3. National Comprehensive Cancer Network. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 1.2023). URL: http://www.nccn.org/professionals/physician_gls/f_guidelines.asp.
4. Hofstetter W. Treatment of clinical T2N0M0 esophageal cancer. Ann Surg Oncol, 2014, 21(12): 3713-3714.
5. Thosani N, Singh H, Kapadia A, et al. Diagnostic accuracy of EUS in differentiating mucosal versus submucosal invasion of superficial esophageal cancers: A systematic review and meta-analysis. Gastrointest Endosc, 2012, 75(2): 242-253.
6. Keswani RN, Early DS, Edmundowicz SA, et al. Routine positron emission tomography does not alter nodal staging in patients undergoing EUS-guided FNA for esophageal cancer. Gastrointest Endosc, 2009, 69(7): 1210-1217.
7. FDA approves selpercatinib for locally advanced or metastatic RET fusion-positive solid tumors. URL: https://prn.to/3dFC8Bz. Accessed on 2022-09-21.
8. Salama AKS, Li S, Macrae ER, et al. Dabrafenib and Trametinib in patients with tumors with BRAFV600E mutations: Results of the NCI-MATCH trial subprotocol H. J Clin Oncol, 2020, 38(33): 3895-3904.
9. Subbiah V, Wolf J, Konda B, et al. Tumour-agnostic efficacy and safety of selpercatinib in patients with RET fusion-positive solid tumours other than lung or thyroid tumours (LIBRETTO-001): A phase 1/2, open-label, basket trial. Lancet Oncol, 2022, 23(10): 1261-1273.
10. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
11. Sun JM, Shen L, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): A randomised, placebo-controlled, phase 3 study. Lancet, 2021, 398(10302): 759-771.
12. FDA grants accelerated approval to pembrolizumab for first tissue/site agnostic indication. URL: https://www.fda.gov/drugs. Accessed on 2020-02-21.
13. Conroy T, Galais MP, Raoul JL, et al. Definitive chemoradiotherapy with FOLFOX versus fluorouracil and cisplatin in patients with oesophageal cancer (PRODIGE5/ACCORD17): Final results of a randomised, phase 2/3 trial. Lancet Oncol, 2014, 15(3): 305-314.
14. Al-Batran SE, Homann N, Pauligk C, et al. Perioperative chemotherapy with fluorouracil plus leucovorin, oxaliplatin, and docetaxel versus fluorouracil or capecitabine plus cisplatin and epirubicin for locally advanced, resectable gastric or gastro-oesophageal junction adenocarcinoma (FLOT4): A randomised, phase 2/3 trial. Lancet, 2019, 393(10184): 1948-1957.
15. Kelsen DP, Ginsberg R, Pajak TF, et al. Chemotherapy followed by surgery compared with surgery alone for localized esophageal cancer. N Engl J Med, 1998, 339(27): 1979-1984.
16. 王镇, 秦建军, 李勇, 等. 从外科视角看可切除颈段食管癌的治疗. 中国胸心血管外科临床杂志, 2020, 27(10): 1217-1222.
17. Ohno K, Nasu M, Matsui H, et al. Real-world treatment patterns and outcomes in Japanese patients with cervical esophageal cancer. Esophagus, 2022, 19(4): 576-585.
18. Liu Y, Huang N, Xu W, et al. A modified tracheal transection approach for cervical esophageal lesion treatment: A report of 13 cases. Front Surg, 2022, 9: 1001488.
19. van Hagen P, Hulshof MC, van Lanschot JJ, et al. Preoperative chemoradiotherapy for esophageal or junctional cancer. N Engl J Med, 2012, 366(22): 2074-2084.
20. Alderson D, Cunningham D, Nankivell M, et al. Neoadjuvant cisplatin and fluorouracil versus epirubicin, cisplatin, and capecitabine followed by resection in patients with oesophageal adenocarcinoma (UK MRC OE05): An open-label, randomised phase 3 trial. Lancet Oncol, 2017, 18(9): 1249-1260.
21. Smalley SR, Benedetti JK, Haller DG, et al. Updated analysis of SWOG-directed intergroup study 0116: A phase Ⅲ trial of adjuvant radiochemotherapy versus observation after curative gastric cancer resection. J Clin Oncol, 2012, 30(19): 2327-2333.
22. Kofoed SC, Muhic A, Baeksgaard L, et al. Survival after adjuvant chemoradiotherapy or surgery alone in resectable adenocarcinoma at the gastro-esophageal junction. Scand J Surg, 2012, 101(1): 26-31.
23. Al-Batran SE, Hartmann JT, Probst S, et al. Phase Ⅲ trial in metastatic gastroesophageal adenocarcinoma with fluorouracil, leucovorin plus either oxaliplatin or cisplatin: A study of the Arbeitsgemeinschaft Internistische Onkologie. J Clin Oncol, 2008, 26(9): 1435-1442.
24. Al-Batran SE, Pauligk C, Homann N, et al. The feasibility of triple-drug chemotherapy combination in older adult patients with oesophagogastric cancer: A randomised trial of the Arbeitsgemeinschaft Internistische Onkologie (FLOT65+). Eur J Cancer, 2013, 49(4): 835-842.
25. Bang YJ, Van Cutsem E, Feyereislova A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): A phase 3, open-label, randomised controlled trial. Lancet, 2010, 376(9742): 687-697.
26. Soularue É, Cohen R, Tournigand C, et al. Efficacy and safety of trastuzumab in combination with oxaliplatin and fluorouracil-based chemotherapy for patients with HER2-positive metastatic gastric and gastro-oesophageal junction adenocarcinoma patients: A retrospective study. Bull Cancer, 2015, 102(4): 324-331.
27. Chung HC, Bang YJ, S Fuchs C, et al. First-line pembrolizumab/placebo plus trastuzumab and chemotherapy in HER2-positive advanced gastric cancer: KEYNOTE-811. Future Oncol, 2021, 17(5): 491-501.
28. Van Cutsem E, Moiseyenko VM, Tjulandin S, et al. Phase Ⅲ study of docetaxel and cisplatin plus fluorouracil compared with cisplatin and fluorouracil as first-line therapy for advanced gastric cancer: A report of the V325 Study Group. J Clin Oncol, 2006, 24(31): 4991-4997.
29. Oppedijk V, van der Gaast A, van Lanschot JJ, et al. Patterns of recurrence after surgery alone versus preoperative chemoradiotherapy and surgery in the CROSS trials. J Clin Oncol, 2014, 32(5): 385-391.
30. Dorth JA, Pura JA, Palta M, et al. Patterns of recurrence after trimodality therapy for esophageal cancer. Cancer, 2014, 120(14): 2099-2105.
31. Sudo K, Xiao L, Wadhwa R, et al. Importance of surveillance and success of salvage strategies after definitive chemoradiation in patients with esophageal cancer. J Clin Oncol, 2014, 32(30): 3400-3405.
32. Taketa T, Sudo K, Correa AM, et al. Post-chemoradiation surgical pathology stage can customize the surveillance strategy in patients with esophageal adenocarcinoma. J Natl Compr Canc Netw, 2014, 12(8): 1139-1144.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the main updates of the NCCN clinical practice guidelines for esophageal and esophagogastric junction cancer (version 1.2023)

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