Integrating adjuvant therapy as standard multimodal treatment for patients with esophageal cancer after neoadjuvant therapy

Recent developments in the treatment paradigm for esophageal cancer have brought major changes in our approach to caring for patients with this disease. Now, both neoadjuvant and adjuvant therapies have become integral components of the multimodal standard treatment delivered to these patients. While there has been a substantial body of evidence in the neoadjuvant realm, progress for adjuvant therapy has been slower. This review aims to provide a comprehensive summary of the current recommendations and newest evolutions in adjuvant treatment following neoadjuvant therapy for patients with esophageal and gastroesophageal cancers. A review of phase II-III randomized controlled trials on the use of adjuvant therapy has been performed. The latest clinical guidelines were examined to identify the evidence-based recommendations on the role of adjuvant therapy after neoadjuvant and surgical treatment for locally advanced esophageal and gastroesophageal cancers. The CheckMate 577 and MATTERHORN are landmark trials that established immunotherapy as standard adjuvant treatment for patients with resectable esophageal and gastroesophageal cancers who had previously received neoadjuvant therapy. In keeping with these advances, there have been ongoing developments to discover other immunotherapy and targeted treatment options to decrease recurrence and improve survival for these patients. Determining the optimal regimen and duration of treatment, as well as finding the appropriate patient selection for adjuvant therapy remains an active area of research. Adjuvant therapy offers patients with resectable esophageal and gastroesophageal cancers a chance for longer disease-free survival. The additions of PD-1/PD-L1 inhibitors have been instrumental in improving outcomes for patients with residual disease despite neoadjuvant therapy. Further work is needed to refine the current treatment regimens and incorporate novel systemic and immunotherapeutic options into our treatment armamentarium.