Oesophageal Cancer — SCE Medical Oncology MCQ

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HardGI CancersOesophageal CancerSCE Medical Oncology

After CROSS chemoradiotherapy and R0 oesophagectomy, pathology shows ypT2N1 adenocarcinoma with residual viable tumour. Recovery is satisfactory. Which postoperative systemic treatment has the matching NICE indication?

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Correct answer: D — Nivolumab for up to twelve months

Explanation lettering: B = shown as A · A = shown as B · E = shown as C · C = shown as E

D is correct. NICE TA746 recommends adjuvant nivolumab after complete resection of oesophageal or gastro-oesophageal junction cancer when residual pathological disease remains after neoadjuvant chemoradiotherapy. The CheckMate 577 schedule continued for up to one year. Capecitabine and cisplatin-fluorouracil are not the appraised post-CROSS adjuvant regimens. Pembrolizumab is not interchangeable with nivolumab for this indication, and surveillance alone omits an available recurrence-delaying treatment in an eligible patient. R0 resection and residual disease are both important: gross residual or metastatic disease would invoke a different pathway.

Reference: NICE TA746 adjuvant nivolumab recommendations: https://www.nice.org.uk/guidance/ta746/chapter/1-Recommendations