Survival Gains and Challenges: The CROSS Trial in GEJ Cancer

Yanghee Woo, MD, surgical oncologist in the Division of Surgical Oncology, associate professor in the Department of Surgery, vice chair of international affairs, director of the Gastroenterology and Minimally Invasive Therapies Program at City of Hope, discusses the details and lasting impact of the CROSS trial in the treatment of gastroesophageal junction (GEJ) and esophageal cancers.

Transcription:0:09 | The CROSS trial included patients, not just with adenocarcinoma, but with squamous cell carcinoma as well. Overall, their survival benefit for adenocarcinoma was an overall median survival of 43 months vs 27 months. Unfortunately, it was very close to being statistically significant, but it was not as significant as for those patients who had squamous cell adenocarcinoma of the esophagus. There was a marked improvement in patients with squamous cell.

0:50 | The 16-month overall survival benefit is real, so despite the nonsignificance, this became standard of care. The study did include 76% of patients with esophageal and only 24% of patients with GEJ tumors, so we need to consider these things when we are sort of evaluating the clinical trial results.

1:18 | In terms of overall survival rates, CROSS did a good job with chemoradiation therapy before surgery for our patients vs surgery alone. Additionally in the Journal of Clinical Oncology in 2021, this concern about the overall survival benefit of the CROSS regiment was brought up. The 10-year overall survival benefit for CROSS persisted, and we saw that 38% of the patients who received neoadjuvant therapy plus surgery vs surgery alone remained alive. [For] surgery alone, only 25% of the patients were alive in 10 years after their surgery, but with the chemo XRT, 38 patients were alive.

2:24 | In this 10-year overall survival benefit, which means that 68% to 75% of these patients had died, and what was notable was that comparing the 2 regimens showed no improvement in isolated distant recurrence control, meaning that with chemo XRT, we fail to control this recurrences or metastases compared with surgery alone. That goes to highlight the strength of the neoadjuvant chemo XRT improving the real R0 rate for surgical resection.