Ken Kato¹, Jin Ye Yeo²

¹Department of Head and Neck, Esophageal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan; ²AOE Editorial Office, AME Publishing Company

Correspondence to: Jin Ye Yeo. AOE Editorial Office, AME Publishing Company. Email: aoe@amegroups.com

Expert introduction

Dr. Ken Kato (Figure 1) is a medical oncologist and chief of the Department of Head and Neck, and Esophageal Medical Oncology, and Gastrointestinal Medical Oncology, National Cancer Center Hospital from 2020-2023, and chief of Biobank Translational Research Support Section, Clinical Research Coordinating Section, Clinical Research Support Office, National Cancer Center Hospital. His primary interest is in chemotherapy and chemoradiotherapy for oesophageal, esophagogastric, and gastric cancer.

Dr. Kato is one of the group coordinators of the Japan Esophageal Oncology Group of JCOG, the most significant clinical trial group for cancer in Japan. His group has conducted clinical trials to develop new chemotherapy for metastatic disease and early oesophageal cancer in multimodality therapy. As a study coordinator, Dr. Kato conducted the randomized phase III trial, which compared the surgery and chemoradiotherapy for clinical stage I oesophageal squamous carcinoma, named JCOG0502, which reported the non-inferiority of chemoradiotherapy to surgery. The randomized phase III trial of neoadjuvant therapy for resectable oesophageal squamous cell carcinoma, named JCOG1109, showed superior survival of triplet-chemotherapy over doublet-chemotherapy. This trial gave a new aspect to neoadjuvant therapy for esophageal cancer. To develop new drugs, such as immune-checkpoint inhibitors, Dr. Kato committed to the international phase III trial of oesophageal cancer as a steering committee member, for example, ATTRACTION-3 KEYNOTE-590, CheckMate-648, RATIONALE-306, and others.

As the director of the Japan Esophageal Society (JES) and the International Society of Disease of Esophagus (ISDE), Dr. Kato is committed to international conferences in Asia and public relations activity.

Figure 1 Dr. Ken Kato

Interview

AOE: What motivated you to pursue esophageal oncology, and dedicate your research to chemotherapy and chemoradiotherapy of esophageal cancer?

Dr. Kato: My motivation to specialize in esophageal oncology stemmed from a deep-seated passion to make a meaningful impact in treating one of the most challenging cancers. Esophageal cancer presents unique therapeutic challenges due to its aggressive nature and often late-stage diagnosis. Through my research, focusing on chemotherapy and chemoradiotherapy, I aim to enhance treatment outcomes and improve quality of life for patients facing this formidable disease. By dedicating myself to understanding the complexities of esophageal cancer treatment, I strive to contribute to advancements that offer new hope and improved survival rates for patients worldwide.

AOE: Could you provide an overview of the progress in chemotherapy and chemoradiotherapy for esophageal cancer? How has this progress improved patient outcomes?

Dr. Kato: The progress in chemotherapy and chemoradiotherapy for esophageal cancer has been significant over recent years. We have witnessed advancements in treatment protocols, including the development of more effective drug combinations with immune checkpoint inhibitors. These innovations have led to improved response rate, and enhanced overall survival for patients.

Furthermore, the integration of chemotherapy with surgical approaches has allowed for more effective local tumor control and reduced the risk of recurrence. Intensive chemotherapy with triplet chemotherapeutic drugs improves the overall survival as a neoadjuvant treatment. We expect more intensive therapy with immune checkpoint inhibitor for neoadjuvant therapy to improve the survival more, and organ preservation after induction chemotherapy followed by chemoradiotherapy.

AOE: In your opinion, what are the critical factors in the selection of treatment for esophageal squamous cell carcinoma (ESCC)?

Dr. Kato: In the selection of treatment for ESCC, several critical factors come into play. Firstly, the stage of the cancer, determined by the extent of tumor spread and involvement of nearby lymph nodes, guides treatment decisions. Early-stage ESCC may be effectively managed with surgery alone, whereas advanced stages often require a multimodal approach involving chemotherapy, radiation, and possibly surgery.

Secondly, the patient's overall health and fitness play a crucial role. Assessing factors such as age, comorbidities, and functional status helps determine tolerance to aggressive treatments like surgery or intensive chemoradiotherapy.

Additionally, the tumor's molecular characteristics, such as biomarker profiles, can influence treatment choices, especially with the advent of targeted therapies that may improve response rates and reduce toxicity compared to traditional approaches.

Lastly, patient preferences and goals of care are integral in decision-making, ensuring that treatment aligns with individual values and expectations regarding quality of life and long-term outcomes.

By carefully weighing these factors in a multidisciplinary setting, we can tailor treatment plans that maximize effectiveness while minimizing potential side effects, ultimately aiming to improve outcomes and quality of life for patients with ESCC.

AOE: The randomized phase III trial of neoadjuvant therapy for resectable ESCC, JCOG1109 NExT, showed superior survival of triplet-chemotherapy followed by esophagectomy over doublet-chemotherapy (1). How has this finding paved the way for the future of neoadjuvant therapy for esophageal cancer?

Dr. Kato: I emphasize the importance of systemic control through intensive chemotherapy to enhance the long-term survival of ESCC patients. Surgical techniques have improved annually. I believe radiotherapy is unnecessary for all patients before surgery, but it is essential for treating local recurrences afterward. Intensifying systemic control could significantly enhance outcomes.

AOE: From your experience in multiple international phase III trials, what are some significant challenges you have faced? Could you share your key takeaways from these experiences?

Dr. Kato: In my experience with multiple international phase III trials, several significant challenges have arisen. One common challenge is ensuring consistent adherence to protocol across diverse clinical settings and healthcare systems. Variations in patient demographics, disease characteristics, and standard practices can complicate data interpretation and result reliability.

From these experiences, I have learned the critical importance of meticulous planning, effective communication among multidisciplinary teams, and flexibility in adapting trial protocols to local contexts while maintaining scientific rigor. Collaborative partnerships with international colleagues have been invaluable, fostering innovation and enriching our understanding of global treatment outcomes.Ultimately, these trials underscore the imperative of patient-centered research and the potential for transformative advancements in cancer care through rigorous international collaboration.

AOE: As one of the leaders in the Japan Esophageal Society (JES) and the International Society of Disease of Esophagus (ISDE), how do you envision international conferences and public relations activities to further drive the research in esophageal cancer?

Dr. Kato: These platforms serve as crucial forums for researchers, clinicians, and stakeholders from around the world to exchange knowledge, share ground-breaking research findings, and foster collaborations. The nature of esophageal cancer differs between Europe and the United States and Asia, but it is important to understand these differences and discuss them at the same table.

AOE: As an Editorial Board Member, what are your expectations for AOE?

Dr. Kato: I wish for AOE to continue collecting high-quality research papers.

Reference

1. Kato K, Machida R, Ito Y, et al. Doublet Chemotherapy, Triplet Chemotherapy, or Doublet Chemotherapy Combined with Radiotherapy as Neoadjuvant Treatment for Locally Advanced Oesophageal Cancer (JCOG1109 NExT): A Randomised, Controlled, Open-Label, Phase 3 Trial. The Lancet. 2024; p. S0140673624007451. doi:10.1016/S0140-6736(24)00745-1.