Advances in Approaches to Managing Esophageal Adenocarcinoma

Management of esophageal adenocarcinoma is moving toward personalized, multimodal approaches, with perioperative immunotherapy now a key component. Shortly before 2025, perioperative 5-fluorouracil, leucovorin, oxaliplatin, and docetaxel (FLOT) chemotherapy was established as superior to neoadjuvant chemoradiotherapy, significantly improving overall survival by better controlling micrometastatic disease. Recent US Food and Drug Administration and European Medical Agency approvals of perioperative durvalumab adds immunotherapy to FLOT. Organ-preserving "watch-and-wait" strategies are gaining momentum for clinical complete responders to avoid surgery-related morbidity. We highlight landmark studies that inform use of different modern multimodal approaches. These advances, combined with robot-assisted surgery, are collectively improving 5-year survival for localized disease.