Neoadjuvant Chemoradiotherapy Combined with Atezolizumab for Resectable Esophageal Adenocarcinoma: A Single Arm Phase II Feasibility Trial (PERFECT)

Tom van den Ende, Nicolien de Clercq, Mark I van Berge Henegouwen, Suzanne S Gisbertz, Debby Geijsen, Rob Verhoeven, Sybren L Meijer, Sandor Schokker, Mark Dings, Jacques J G H M Bergman, Nadia Haj Mohammad, Jelle P Ruurda, Richard van Hillegersberg, Stella Mook, Max Nieuwdorp, Tanja D de Gruijl, Tanya T D Soeratram, Bauke Ylstra, Nicole C T van Grieken, Maarten F BijlsmaMaarten C C M Hulshof, Hanneke W van Laarhoven

Research output: Contribution to journalArticleAcademicpeer-review


Purpose: The CROSS trial established neoadjuvant chemoradiotherapy (nCRT) for patients with resectable esophageal adenocarcinoma (rEAC). In the PERFECT trial, we investigated the feasibility and efficacy of nCRT combined with programmeddeath ligand-1 (PD-L1) inhibition for rEAC. Patients and Methods: Patients with rEAC received nCRT according to the CROSS regimen combined with five cycles of atezolizumab (1, 200 mg). The primary endpoint was the feasibility of administering five cycles of atezolizumab in ≥75% patients. A propensity score-matched nCRT cohort was used to compare pathologic response, overall survival, and progression-free survival. Exploratory biomarker analysis was performed on repeated tumor biopsies. Results: We enrolled 40 patients of whom 85% received all cycles of atezolizumab. Immune-related adverse events of any grade were observed in 6 patients. In total, 83% proceeded to surgery. Reasons for not undergoing surgery were progression (n = 4), patient choice (n = 2), and death (n = 1). The pathologic complete response rate was 25% (10/40). No statistically significant difference in response or survival was found between the PERFECT and the nCRT cohort. Baseline expression of an established IFNg signature was higher in responders compared with nonresponders (P = 0.043). On-treatment nonresponders showed either a high number of cytotoxic lymphocytes (CTL) with a transcriptional signature consistent with expression of immune checkpoints, or a low number of CTLs. Conclusions: Combining nCRT with atezolizumab is feasible in patients with rEAC. On the basis of our exploratory biomarker study, future studies are necessary to elucidate the potential of neoadjuvant immunotherapy in patient subgroups.

Original languageEnglish
Pages (from-to)3351-3359
Number of pages9
JournalClinical cancer research : an official journal of the American Association for Cancer Research
Issue number12
Early online date27 Jan 2021
Publication statusPublished - Jun 2021

Cite this