Current neoadjuvant therapy for operable locally advanced esophageal cancer

Locally advanced esophageal cancer has a poor prognosis, while an increasing number of patients are diagnosed with that. Neoadjuvant therapy has become a hot topic in treating locally advanced esophageal cancer to improve its survival benefit. The efficacy of neoadjuvant therapy followed by surgery has been confirmed by many studies, and neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy are included in the guidelines. In recent years, targeted therapy and immunotherapy have emerged, and more studies are evaluating the efficacy of combining them with neoadjuvant therapy for operable esophageal cancer patients. Even though the preliminary data is disappointing, many trials are still under investigation without improving survival benefits. New indexes used as surrogate endpoints (e.g., major pathologic response and pathological complete response) are emerging to accelerate the development and approval of neoadjuvant drugs. This review summarized the research progress in neoadjuvant therapy for locally advanced esophageal cancer and discussed which primary endpoint should be used in neoadjuvant therapy trials.

Automated summary

Locally advanced esophageal cancer has a poor prognosis, and neoadjuvant therapy has become a hot topic in improving its survival benefit. Various studies have confirmed the efficacy of neoadjuvant therapy followed by surgery, including chemoradiotherapy and chemotherapy. Newer treatments like targeted therapy and immunotherapy are being evaluated for their effectiveness in combination with neoadjuvant therapy. Surrogate endpoints are being developed to speed up the approval of neoadjuvant drugs. This review discusses the research progress and primary endpoints in neoadjuvant therapy for locally advanced esophageal cancer.