Phase 2 FLOT (docetaxel microtubule inhibitor) consolidation after CRT in localized EAC/EGJ

This Duke University single-arm Phase 2 study tests whether adding consolidative multi-agent chemotherapy after standard upfront chemoradiation can improve disease control and increase organ preservation (avoiding esophagectomy) for stage II–IVA esophageal adenocarcinoma or gastroesophageal junction (EGJ) adenocarcinoma. Patients receive routine concurrent chemoradiation, then additional post-CRT systemic therapy with either FOLFOX at the treating physician’s discretion (5-FU thymidylate-synthase inhibition + oxaliplatin DNA crosslinking) or the FLOT regimen (5-FU thymidylate-synthase inhibition + leucovorin biomodulation + oxaliplatin DNA crosslinking + docetaxel microtubule stabilization). The scientific angle is “systemic intensification” in a definitive CRT pathway: CRT can control the primary tumor, but distant relapse remains a major failure mode, so the trial is explicitly trying to suppress micrometastatic disease and reduce surgery rates without sacrificing control. Today’s common care for locally advanced resectable EAC/EGJ is neoadjuvant chemoradiation followed by esophagectomy (or perioperative chemotherapy in selected settings), with adjuvant immunotherapy in some patients after surgery, so this trial explores a nonoperative, consolidation-heavy alternative strategy.