Loading
ESOPEC pitted the two standard ways of treating operable oesophageal adenocarcinoma against each other, chemotherapy before and after surgery or chemoradiotherapy before it, and found that the chemotherapy approach helped people live longer.
ESOPEC was a German multicentre phase 3 trial of 438 patients with resectable adenocarcinoma of the oesophagus or gastro-oesophageal junction, randomised to perioperative FLOT (four cycles before and four after surgery) or to the CROSS regimen of carboplatin and paclitaxel with 41.4 Gy of radiotherapy followed by surgery. The primary endpoint was overall survival.
Perioperative FLOT lengthened overall survival compared with neoadjuvant chemoradiotherapy, with a similar rate of complete resection and postoperative complications. The result, reported in 2024 and published in 2025, tipped guidelines towards perioperative chemotherapy for adenocarcinoma of the oesophagus, and the trials adding immunotherapy to FLOT build on it.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
438 enrolled.
Median follow-up 55 months
Source| Endpoint | Arm | n | Value | HR (95% CI) | p | Source |
|---|---|---|---|---|---|---|
| Overall survival at 3 yearsprimary | Perioperative FLOT + surgery | 221 | 57.4% | 0.7 (0.53 to 0.92) | 0.01 | link |
| Preoperative chemoradiotherapy (41.4 Gy, carboplatin-paclitaxel) + surgery | 217 | 50.7% | ||||
| Progression-free survival at 3 years | Perioperative FLOT + surgery | 221 | 51.6% | 0.66 (0.51 to 0.85) | - | link |
| Preoperative chemoradiotherapy (41.4 Gy, carboplatin-paclitaxel) + surgery | 217 | 35% | ||||
| Mortality at 90 days after surgery | Perioperative FLOT + surgery | - | 3.1% | - | - | link |
| Preoperative chemoradiotherapy (41.4 Gy, carboplatin-paclitaxel) + surgery | - | 5.6% |
Shares Oesophageal and junctional adenocarcinoma, Leucovorin (folinic acid), Oxaliplatin, Fluorouracil (5-FU) and the tag subtype-trials.
Shares Fluorouracil (5-FU), Docetaxel, Cytotoxic chemotherapy and the tag subtype-trials.
Shares Leucovorin (folinic acid), Oxaliplatin, Fluorouracil (5-FU), Cytotoxic chemotherapy and the tag subtype-trials.
Shares Docetaxel, Paclitaxel / nab-paclitaxel and the tag subtype-trials.
Shares Oxaliplatin, Fluorouracil (5-FU) and the tag subtype-trials.
Shares Paclitaxel / nab-paclitaxel, Carboplatin, Cytotoxic chemotherapy and the tag subtype-trials.
Shares Paclitaxel / nab-paclitaxel, Carboplatin, Cytotoxic chemotherapy and the tag subtype-trials.
Shares Carboplatin, Cytotoxic chemotherapy and the tag subtype-trials.