The Lasting Impact of the CROSS Trial on GEJ Cancer Care

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, provides an overview of the CROSS trial which focused on treating patients with gastroesophageal junction (GEJ) cancers.

The CROSS trial was published in 2012 and showed that combining chemotherapy and radiation therapy prior to surgery significantly improved survival rates for patients with GEJ cancer compared with surgery alone. The CROSS chemoradiation regimen consists of carboplatin and paclitaxel for 5 weeks along with concurrent radiotherapy, followed by surgery (chemo XRT).

According to Woo, surgeons aimed to cure GEJ cancers primarily through surgery, but high recurrence rates prompted a search for more effective treatment approaches. Here, she emphasizes the transformative role of the CROSS trial in extending survival and providing more durable disease control in patients with GEJ cancer.

Transcription:

0:09 | Surgeons used to think that we could cure GEJ cancers, and we obviously realized quickly that these patients recur. In search of regimens that would help our patients with GEJ cancers live longer and get better disease control for a durability of time, this regimen took the CROSS trial in 2012 and put the chemo and radiation combination on the map for neoadjuvant therapy. The CROSS trial compared carboplatin and paclitaxel, which are effective systemic treatments for upper GI cancers, 41.4 Gy, and 23 fractions of radiation therapy prior to surgery, in addition to surgery, with surgery alone.

1:12 | The neoadjuvant regimen took 29 days, and the patients waited about 6 weeks and they went to surgery. The bottom line is that chemoradiation before surgery improves survival. This was published in the New England Journal of Medicine, and it changed our practice for GEJ tumors back then.