Neoadjuvant Anlotinib and chemotherapy followed by minimally invasive esophagectomy in patients with locally advanced esophageal squamous cell carcinoma: Short-term results of an open-label, randomized, phase II trial

Ying-Jian Wang; Kun-Kun Li; Xian-Feng Xie; Tao Bao; Zhi-Peng Hao; Jiang Long; Shuai Wang; Zhao-Yang Zhong; Wei Guo

doi:10.3389/fonc.2022.908841

Neoadjuvant Anlotinib and chemotherapy followed by minimally invasive esophagectomy in patients with locally advanced esophageal squamous cell carcinoma: Short-term results of an open-label, randomized, phase II trial

Front Oncol. 2022 Aug 2:12:908841. doi: 10.3389/fonc.2022.908841. eCollection 2022.

Authors

Ying-Jian Wang¹, Kun-Kun Li¹, Xian-Feng Xie¹, Tao Bao¹, Zhi-Peng Hao¹, Jiang Long¹, Shuai Wang², Zhao-Yang Zhong², Wei Guo¹

Affiliations

¹ Department of Thoracic Surgery, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.
² Department of Cancer Center, Daping Hospital, Army Medical University (Third Military Medical University), Chongqing, China.

Abstract

Background: Clinical benefits of neoadjuvant Anlotinib for locally advanced esophageal squamous cell carcinoma (ESCC) remains unclear. This study evaluated the efficacy and safety of neoadjuvant Anlotinib plus chemotherapy followed by minimally invasive esophagectomy (MIE) for the treatment of patients with locally advanced ESCC.

Methods: Patients with locally advanced ESCC were randomly assigned to neoadjuvant Anlotinib combined with chemotherapy (Anlotinib group) or neoadjuvant chemoradiotherapy alone (nCRT group) with an allocation ratio of 1:1. The primary endpoint was the R0 surgical resection rate. Secondary endpoints included postoperative pathologic stage, complete response (CR) rate, and safety. Safety was assessed by adverse events (AEs) and postoperative complications.

Results: From August 2019 to August 2021, 93 patients were assigned to the nCRT or Anlotinib group. Of the 93 patients, 79 underwent MIE and were finally included in the per-protocol set (nCRT group: n=39; Anlotinib group: n=40). The R0 resection rate was 97.4% for nCRT versus 100.0% for Anlotinib group (p>0.05). Compared with the nCRT group, patients in the Anlotinib group had shorter total operation duration (262.2 ± 39.0 vs. 200.7 ± 25.5 min, p=0.010) and less blood loss (161.3 ± 126.7 vs. 52.4 ± 39.3 mL, p<0.001). No significant differences were found in the postoperative pathologic stage between the Anlotinib group and nCRT group (all p>0.05). Besides, the incidences of AEs (80.0% vs. 92.3%) and postoperative complications (22.5% vs. 30.8%) were similar between the two groups (all p>0.05).

Conclusions: Neoadjuvant Anlotinib plus chemotherapy had a similar safety profile and pathologic response, but better surgical outcomes than nCRT for locally advanced ESCC.

Keywords: Anlotinib; chemoradiotherapy; chemotherapy; esophageal squamous cell carcinoma; minimally invasive esophagectomy; neoadjuvant therapy.