Efficacy and safety of systemic chemotherapy for radically resectable esophago-gastric adenocarcinoma in older patients: A systematic review and meta-analysis

Introduction: A significant proportion of locally-advanced esophago-gastric adenocarcinoma (EGA) is diagnosed in patients >= 70 years old (y.o.) who are commonly underrepresented in clinical trials.Materials and Methods: The PubMed database was searched for phase 2/3 clinical trials enrolling patients >= 70 y.o and reporting efficacy/safety information of chemotherapy for resectable EGA. The main outcomes were overall survival (OS) and recurrence-free survival (RFS).Results: Among 6,128 records, only seven studies reported these outcomes (three peri-operative, three adjuvant, and one neoadjuvant), including 1004 older patients, <20% of the overall population. No significant benefit in terms of OS and RFS was observed for perioperative or adjuvant chemotherapy vs surgery alone. No trial reported safety endpoints in this subgroup.Discussion: This work did not show any significant benefit in OS or RFS for chemotherapy vs surgery alone or conventional vs de-escalated chemotherapy in the curative setting of EGA in >= 70 y.o patients. Specific ad hoc trials should be performed to derive reliable data.