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The bolded is your problem my friend. Potentially resectable patients far outnumber patients who are outright unresectable. The longer a trial goes on, the more expensive it is. On top of that, unresectable patients have more issues with competing mortality. Everyone doling out the cash wants the most immediate ROI they can get. But, since the distant met rate after surgery and SOC approaches 50%, it is very feasible to do an adjuvant IO trial in resected patients. And the trial has already been done. And was positive. Checkmate577:
I am aware of adj Nivo after surgery... as I mentioned in my post...
Most of my esophageal cancer patients don't get surgery. That could be because of the severity of the disease or them refusing esophagectomy due to the QoL hit. There should be a trial evaluating consolidative IT in those who do not get surgery, perhaps including those hwo refuse surgery as well.
I don't know if surgery is still worth it in these patients whether the QoL is worth it for most of the 75-80 year olds I see.