Interpretation of the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2022)_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JI Gang ¹ , WEI Jiangpeng ¹ ,  LU Qiang ²

1. Department of Digestive Surgery, Xijing Hospital, Air Force Military Medical University, Xi'an, 710032, P. R. China;
2. Department of Thoracic Surgery, Tangdu Hospital, Air Force Military Medical University, Xi'an, 710038, P. R. China;

Corresponding author：

LU Qiang, Email: luqiang@fmmu.edu.cn

Keywords：

Esophageal cancer; esophagogastric junction cancer; National Comprehensive Cancer Network; guideline interpretation

DOI：

10.7507/1007-4848.202209006

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

The National Comprehensive Cancer Network (NCCN) has updated and released the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2022). Compared with the version 4 of the guidelines in 2021, the 3 versions in 2022 have some updates and revisions, mainly focusing on molecular marker detection, perioperative treatment, advanced immunotherapy, radiotherapy and other aspects. This article will interpret the main content of the new edition of the guidelines, in order to enhance the understanding of the guidelines and guide the clinical practice of diagnosis and treatment.

Citation： JI Gang, WEI Jiangpeng, LU Qiang. Interpretation of the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2022). Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2022, 29(11): 1414-1423. doi: 10.7507/1007-4848.202209006 Copy

1.	Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2.	Smyth EC, Lagergren J, Fitzgerald RC, et al. Oesophageal cancer. Nat Rev Dis Primers, 2017, 3: 17048.
3.	Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
4.	NCCN. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version3.2022). URL: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1433.
5.	NCCN. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version4.2021). URL: https://www.nccn.org/.
6.	中国临床肿瘤学会肿瘤标志物专家委员会, 中国肿瘤驱动基因分析联盟. 二代测序技术在肿瘤精准医学诊断中的应用专家共识. 中华医学杂志, 2018, 98(26): 2057-2065.
7.	Konczalla L, Wöstemeier A, Kemper M, et al. Clinical significance of circulating tumor cells in gastrointestinal carcinomas. Diagnostics (Basel), 2020, 10(4): 192.
8.	Li Y, Wu G, Yang W, et al. Prognostic value of circulating tumor cells detected with the CellSearch system in esophageal cancer patients: A systematic review and meta-analysis. BMC Cancer, 2020, 20(1): 581.
9.	Azad TD, Chaudhuri AA, Fang P, et al. Circulating tumor DNA analysis for detection of minimal residual disease after chemoradiotherapy for localized esophageal cancer. Gastroenterology, 2020, 158(3): 494-505.
10.	Matsushita D, Arigami T, Okubo K, et al. The diagnostic and prognostic value of a liquid biopsy for esophageal cancer: A systematic review and meta-analysis. Cancers (Basel), 2020, 12(10): 3070.
11.	Yuan Z, Wang X, Geng X, et al. Liquid biopsy for esophageal cancer: Is detection of circulating cell-free DNA as a biomarker feasible? Cancer Commun (Lond), 2021, 41(1): 3-15.
12.	Yan X, Zhao J, Lei J, et al. 144P Tislelizumab combined with chemotherapy as neoadjuvant therapy for surgically resectable esophageal cancer (TD-NICE): A single arm, phase Ⅱ study. Ann Oncol, 2021, 32(suppl_7): S1428-S1457.
13.	Shen D, Chen Q, Wu J, et al. The safety and efficacy of neoadjuvant PD-1 inhibitor with chemotherapy for locally advanced esophageal squamous cell carcinoma. J Gastrointest Oncol, 2021, 12(1): 1-10.
14.	Liu J, Li J, Lin W, et al. Neoadjuvant camrelizumab plus chemotherapy for resectable, locally advanced esophageal squamous cell carcinoma (NIC-ESCC2019): A multicenter, phase 2 study. Int J Cancer, 2022, 151(1): 128-137.
15.	Li ZG, Liu J, Zhang M, et al. A phase Ⅱ study of neoadjuvant immunotherapy combined with chemotherapy (camrelizumab plus albumin paclitaxel and carboplatin) in resectable thoracic esophageal squamous cell cancer (NICE study): Interim results. J Clin Oncol, 2021, 39(15_suppl): 4060.
16.	Shang X, Zhang C, Zhao G, et al. Safety and efficacy of pembrolizumab combined with paclitaxel and cisplatin as a neoadjuvant treatment for locally advanced resectable (stage Ⅲ) esophageal squamous cell carcinoma (Keystone-001): Interim analysis of a prospective, single-arm, single-center, phase Ⅱ trial. Ann Oncol, 2021, 32: S1428-S1429.
17.	Liu DL, Zhang Q, Zhu JH, et al. Phase Ⅱ study of toripalimab combined with neoadjuvant chemotherapy for the treatment of resectable esophageal squamous cell carcinoma. J Clin Oncol, 2021, 39(15_suppl): e16029.
18.	van den Ende T, de Clercq NC, van Berge Henegouwen MI, et al. Neoadjuvant chemoradiotherapy combined with atezolizumab for resectable esophageal adenocarcinoma: A single-arm phase Ⅱ feasibility trial (PERFECT). Clin Cancer Res, 2021, 27(12): 3351-3359.
19.	Li C, Zhao S, Zheng Y, et al. Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE-1). Eur J Cancer, 2021, 144: 232-241.
20.	Matsuda S, Yamamoto S, Kato K, et al. FRONTiER: A feasibility trial of nivolumab with neoadjuvant CF or DCF, FLOT therapy for locally advanced esophageal carcinoma (JCOG1804E)—Short-term results for cohorts C and D. J Clin Oncol, 2022, 40(4_suppl): 286.
21.	中国临床肿瘤学会指南工作委员会. 食管癌诊疗指南( 2022版). 北京: 人民卫生出版社, 2022.
22.	Moehler M, Ajani J, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer following neoadjuvant chemoradiotherapy: 14-month follow-up of CheckMate 577. Poster presentation at the 2021 European Society of Medical Oncology (ESMO) Annual Meeting, 2021.
23.	Kato K, Ito Y, Daiko H, et al. A randomized controlled phase Ⅲ trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT study. J Clin Oncol, 2022, 40(4_suppl): 238.
24.	Ilson D H, Forastiere A, Arquette M, et al. A phase Ⅱ trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J, 2000, 6(5): 316-323.
25.	Ilson DH, Wadleigh RG, Leichman LP, et al. Paclitaxel given by a weekly 1-h infusion in advanced esophageal cancer. Ann Oncol, 2007, 18(5): 898-902.
26.	Bleiberg H, Conroy T, Paillot B, et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer, 1997, 33(8): 1216-1220.
27.	Lee SJ, Kim S, Kim M, et al. Capecitabine in combination with either cisplatin or weekly paclitaxel as a first-line treatment for metastatic esophageal squamous cell carcinoma: A randomized phase Ⅱ study. BMC Cancer, 2015, 15: 693.
28.	Ian Chau, Yuichiro Doki, Jaffer A, et al. Nivolumab (NIVO) plus ipilimumab (IPI) or NIVO plus chemotherapy (chemo) versus chemo as first-line (1L) treatment for advanced esophageal squamous cell carcinoma (ESCC): First results of the CheckMate 648 study. J Clin Oncol, 2021, 39(18_suppl): LBA4001.
29.	Doki Y, Ajani JA, Kato K, et al. Nivolumab combination therapy in advanced esophageal squamous-cell carcinoma. N Engl J Med, 2022, 386(5): 449-462.
30.	U. S. Food and Drug Administration. FDA approves Opdivo in combination with chemotherapy and Opdivo in combination with Yervoy for first-line esophageal squamous cell carcinoma indications. URL: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-opdivo-combination-chemotherapy-and-opdivo-combination-yervoy-first-line-esophageal (2022-05-07).
31.	Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
32.	Shitara K, Ajani JA, Moehler M, et al. Nivolumab plus chemotherapy or ipilimumab in gastro-oesophageal cancer. Nature, 2022, 603(7903): 942-948.
33.	Shen L, Bai YX, Lin XY, et al. First-line nivolumab plus chemotherapy vs chemotherapy in patients with advanced gastric cancer/gastroesophageal junction cancer/esophageal adenocarcinoma: CheckMate 649 Chinese subgroup analysis 2-year follow-up. ESMO World GI, 2022: Abstract 86.
34.	Sun JM, Shen L, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): A randomised, placebo-controlled, phase 3 study. Lancet, 2021, 398(10302): 759-771.
35.	Lu Z, Wang J, Shu Y, et al. Sintilimab versus placebo in combination with chemotherapy as first line treatment for locally advanced or metastatic oesophageal squamous cell carcinoma (ORIENT-15): Multicentre, randomised, double blind, phase 3 trial. BMJ, 2022, 377: e068714.
36.	Wang ZX, Cui C, Yao J, et al. Toripalimab plus chemotherapy in treatment-naïve, advanced esophageal squamous cell carcinoma (JUPITER-06): A multi-center phase 3 trial. Cancer Cell, 2022, 40(3): 277-288.
37.	Luo H, Lu J, Bai Y, et al. Effect of camrelizumab vs placebo added to chemotherapy on survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma: The ESCORT-1st randomized clinical trial. JAMA, 2021, 326(10): 916-925.
38.	Yoon HH, Kato K, Raymond E, et al. RATIONALE-306: Randomized, global, Phase 3 study of tislelizumab plus chemotherapy versus chemotherapy as first-line treatment for locally advanced unresectable or metastatic esophageal squamous cell carcinoma (ESCC). 2022ESMO-WCGI: Abstract LBA1.
39.	Berton D, Banerjee SN, Curigliano G, et al. Antitumor activity of dostarlimab in patients with mismatch repair-deficient/microsatellite instability–high tumors: A combined analysis of two cohorts in the GARNET study. J Clin Oncol, 2021, 39(15_suppl): Abstract 2564.
40.	U. S. Food and Drug Administration. FDA grants accelerated approval to dostarlimab-gxly for dMMR advanced solid tumors. 2021.
41.	Amonkar M, Lorenzi M, Zhang J, et al. Structured literature review (SLR) and meta-analyses of the prevalence of microsatellite instability high (MSI-H) and deficient mismatch repair (dMMR) in gastric, colorectal, and esophageal cancers. J Clin Oncol, 2019, 37(suppl 15): Abstract e15074.
42.	Zang YS, Dai C, Xu X, et al. Comprehensive analysis of potential immunotherapy genomic biomarkers in 1000 Chinese patients with cancer. Cancer Med, 2019, 8(10): 4699-4708.
43.	Hause RJ, Pritchard CC, Shendure J, et al. Classification and characterization of microsatellite instability across 18 cancer types. Nat Med, 2016, 22(11): 1342-1350.
44.	Fang WL, Chen MH, Huang KH, et al. The clinicopathological features and genetic mutations in gastric cancer patients according to EMAST and MSI status. Cancers (Basel), 2020, 12(3): 551.

1. Sung H, Ferlay J, Siegel RL, et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2021, 71(3): 209-249.
2. Smyth EC, Lagergren J, Fitzgerald RC, et al. Oesophageal cancer. Nat Rev Dis Primers, 2017, 3: 17048.
3. Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022. CA Cancer J Clin, 2022, 72(1): 7-33.
4. NCCN. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version3.2022). URL: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1433.
5. NCCN. The NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version4.2021). URL: https://www.nccn.org/.
6. 中国临床肿瘤学会肿瘤标志物专家委员会, 中国肿瘤驱动基因分析联盟. 二代测序技术在肿瘤精准医学诊断中的应用专家共识. 中华医学杂志, 2018, 98(26): 2057-2065.
7. Konczalla L, Wöstemeier A, Kemper M, et al. Clinical significance of circulating tumor cells in gastrointestinal carcinomas. Diagnostics (Basel), 2020, 10(4): 192.
8. Li Y, Wu G, Yang W, et al. Prognostic value of circulating tumor cells detected with the CellSearch system in esophageal cancer patients: A systematic review and meta-analysis. BMC Cancer, 2020, 20(1): 581.
9. Azad TD, Chaudhuri AA, Fang P, et al. Circulating tumor DNA analysis for detection of minimal residual disease after chemoradiotherapy for localized esophageal cancer. Gastroenterology, 2020, 158(3): 494-505.
10. Matsushita D, Arigami T, Okubo K, et al. The diagnostic and prognostic value of a liquid biopsy for esophageal cancer: A systematic review and meta-analysis. Cancers (Basel), 2020, 12(10): 3070.
11. Yuan Z, Wang X, Geng X, et al. Liquid biopsy for esophageal cancer: Is detection of circulating cell-free DNA as a biomarker feasible? Cancer Commun (Lond), 2021, 41(1): 3-15.
12. Yan X, Zhao J, Lei J, et al. 144P Tislelizumab combined with chemotherapy as neoadjuvant therapy for surgically resectable esophageal cancer (TD-NICE): A single arm, phase Ⅱ study. Ann Oncol, 2021, 32(suppl_7): S1428-S1457.
13. Shen D, Chen Q, Wu J, et al. The safety and efficacy of neoadjuvant PD-1 inhibitor with chemotherapy for locally advanced esophageal squamous cell carcinoma. J Gastrointest Oncol, 2021, 12(1): 1-10.
14. Liu J, Li J, Lin W, et al. Neoadjuvant camrelizumab plus chemotherapy for resectable, locally advanced esophageal squamous cell carcinoma (NIC-ESCC2019): A multicenter, phase 2 study. Int J Cancer, 2022, 151(1): 128-137.
15. Li ZG, Liu J, Zhang M, et al. A phase Ⅱ study of neoadjuvant immunotherapy combined with chemotherapy (camrelizumab plus albumin paclitaxel and carboplatin) in resectable thoracic esophageal squamous cell cancer (NICE study): Interim results. J Clin Oncol, 2021, 39(15_suppl): 4060.
16. Shang X, Zhang C, Zhao G, et al. Safety and efficacy of pembrolizumab combined with paclitaxel and cisplatin as a neoadjuvant treatment for locally advanced resectable (stage Ⅲ) esophageal squamous cell carcinoma (Keystone-001): Interim analysis of a prospective, single-arm, single-center, phase Ⅱ trial. Ann Oncol, 2021, 32: S1428-S1429.
17. Liu DL, Zhang Q, Zhu JH, et al. Phase Ⅱ study of toripalimab combined with neoadjuvant chemotherapy for the treatment of resectable esophageal squamous cell carcinoma. J Clin Oncol, 2021, 39(15_suppl): e16029.
18. van den Ende T, de Clercq NC, van Berge Henegouwen MI, et al. Neoadjuvant chemoradiotherapy combined with atezolizumab for resectable esophageal adenocarcinoma: A single-arm phase Ⅱ feasibility trial (PERFECT). Clin Cancer Res, 2021, 27(12): 3351-3359.
19. Li C, Zhao S, Zheng Y, et al. Preoperative pembrolizumab combined with chemoradiotherapy for oesophageal squamous cell carcinoma (PALACE-1). Eur J Cancer, 2021, 144: 232-241.
20. Matsuda S, Yamamoto S, Kato K, et al. FRONTiER: A feasibility trial of nivolumab with neoadjuvant CF or DCF, FLOT therapy for locally advanced esophageal carcinoma (JCOG1804E)—Short-term results for cohorts C and D. J Clin Oncol, 2022, 40(4_suppl): 286.
21. 中国临床肿瘤学会指南工作委员会. 食管癌诊疗指南( 2022版). 北京: 人民卫生出版社, 2022.
22. Moehler M, Ajani J, Kuzdzal J, et al. Adjuvant nivolumab in resected esophageal or gastroesophageal junction cancer following neoadjuvant chemoradiotherapy: 14-month follow-up of CheckMate 577. Poster presentation at the 2021 European Society of Medical Oncology (ESMO) Annual Meeting, 2021.
23. Kato K, Ito Y, Daiko H, et al. A randomized controlled phase Ⅲ trial comparing two chemotherapy regimen and chemoradiotherapy regimen as neoadjuvant treatment for locally advanced esophageal cancer, JCOG1109 NExT study. J Clin Oncol, 2022, 40(4_suppl): 238.
24. Ilson D H, Forastiere A, Arquette M, et al. A phase Ⅱ trial of paclitaxel and cisplatin in patients with advanced carcinoma of the esophagus. Cancer J, 2000, 6(5): 316-323.
25. Ilson DH, Wadleigh RG, Leichman LP, et al. Paclitaxel given by a weekly 1-h infusion in advanced esophageal cancer. Ann Oncol, 2007, 18(5): 898-902.
26. Bleiberg H, Conroy T, Paillot B, et al. Randomised phase II study of cisplatin and 5-fluorouracil (5-FU) versus cisplatin alone in advanced squamous cell oesophageal cancer. Eur J Cancer, 1997, 33(8): 1216-1220.
27. Lee SJ, Kim S, Kim M, et al. Capecitabine in combination with either cisplatin or weekly paclitaxel as a first-line treatment for metastatic esophageal squamous cell carcinoma: A randomized phase Ⅱ study. BMC Cancer, 2015, 15: 693.
28. Ian Chau, Yuichiro Doki, Jaffer A, et al. Nivolumab (NIVO) plus ipilimumab (IPI) or NIVO plus chemotherapy (chemo) versus chemo as first-line (1L) treatment for advanced esophageal squamous cell carcinoma (ESCC): First results of the CheckMate 648 study. J Clin Oncol, 2021, 39(18_suppl): LBA4001.
29. Doki Y, Ajani JA, Kato K, et al. Nivolumab combination therapy in advanced esophageal squamous-cell carcinoma. N Engl J Med, 2022, 386(5): 449-462.
30. U. S. Food and Drug Administration. FDA approves Opdivo in combination with chemotherapy and Opdivo in combination with Yervoy for first-line esophageal squamous cell carcinoma indications. URL: https://www.fda.gov/drugs/resources-information-approved-drugs/fda-approves-opdivo-combination-chemotherapy-and-opdivo-combination-yervoy-first-line-esophageal (2022-05-07).
31. Janjigian YY, Shitara K, Moehler M, et al. First-line nivolumab plus chemotherapy versus chemotherapy alone for advanced gastric, gastro-oesophageal junction, and oesophageal adenocarcinoma (CheckMate 649): A randomised, open-label, phase 3 trial. Lancet, 2021, 398(10294): 27-40.
32. Shitara K, Ajani JA, Moehler M, et al. Nivolumab plus chemotherapy or ipilimumab in gastro-oesophageal cancer. Nature, 2022, 603(7903): 942-948.
33. Shen L, Bai YX, Lin XY, et al. First-line nivolumab plus chemotherapy vs chemotherapy in patients with advanced gastric cancer/gastroesophageal junction cancer/esophageal adenocarcinoma: CheckMate 649 Chinese subgroup analysis 2-year follow-up. ESMO World GI, 2022: Abstract 86.
34. Sun JM, Shen L, Shah MA, et al. Pembrolizumab plus chemotherapy versus chemotherapy alone for first-line treatment of advanced oesophageal cancer (KEYNOTE-590): A randomised, placebo-controlled, phase 3 study. Lancet, 2021, 398(10302): 759-771.
35. Lu Z, Wang J, Shu Y, et al. Sintilimab versus placebo in combination with chemotherapy as first line treatment for locally advanced or metastatic oesophageal squamous cell carcinoma (ORIENT-15): Multicentre, randomised, double blind, phase 3 trial. BMJ, 2022, 377: e068714.
36. Wang ZX, Cui C, Yao J, et al. Toripalimab plus chemotherapy in treatment-naïve, advanced esophageal squamous cell carcinoma (JUPITER-06): A multi-center phase 3 trial. Cancer Cell, 2022, 40(3): 277-288.
37. Luo H, Lu J, Bai Y, et al. Effect of camrelizumab vs placebo added to chemotherapy on survival and progression-free survival in patients with advanced or metastatic esophageal squamous cell carcinoma: The ESCORT-1st randomized clinical trial. JAMA, 2021, 326(10): 916-925.
38. Yoon HH, Kato K, Raymond E, et al. RATIONALE-306: Randomized, global, Phase 3 study of tislelizumab plus chemotherapy versus chemotherapy as first-line treatment for locally advanced unresectable or metastatic esophageal squamous cell carcinoma (ESCC). 2022ESMO-WCGI: Abstract LBA1.
39. Berton D, Banerjee SN, Curigliano G, et al. Antitumor activity of dostarlimab in patients with mismatch repair-deficient/microsatellite instability–high tumors: A combined analysis of two cohorts in the GARNET study. J Clin Oncol, 2021, 39(15_suppl): Abstract 2564.
40. U. S. Food and Drug Administration. FDA grants accelerated approval to dostarlimab-gxly for dMMR advanced solid tumors. 2021.
41. Amonkar M, Lorenzi M, Zhang J, et al. Structured literature review (SLR) and meta-analyses of the prevalence of microsatellite instability high (MSI-H) and deficient mismatch repair (dMMR) in gastric, colorectal, and esophageal cancers. J Clin Oncol, 2019, 37(suppl 15): Abstract e15074.
42. Zang YS, Dai C, Xu X, et al. Comprehensive analysis of potential immunotherapy genomic biomarkers in 1000 Chinese patients with cancer. Cancer Med, 2019, 8(10): 4699-4708.
43. Hause RJ, Pritchard CC, Shendure J, et al. Classification and characterization of microsatellite instability across 18 cancer types. Nat Med, 2016, 22(11): 1342-1350.
44. Fang WL, Chen MH, Huang KH, et al. The clinicopathological features and genetic mutations in gastric cancer patients according to EMAST and MSI status. Cancers (Basel), 2020, 12(3): 551.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the NCCN esophageal and esophagogastric junction cancers clinical practice guidelines in oncology (version 3. 2022)

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content