Total Neoadjuvant Treatment in Oesophageal Adenocarcinoma: The TNT-OAC trial feasibility study
Research type
Research Study
Full title
Multi-centre, three-arm Phase II/III feasibility, randomised control trial to compare total neoadjuvant treatment (TNT) to standard of care perioperative chemotherapy in patients with newly diagnosed oesophageal adenocarcinoma (OAC) eligible for surgery.
IRAS ID
1012559
Contact name
Russell Petty
Contact email
Sponsor organisation
University of Dundee/NHS Tayside
ISRCTN Number
ISRCTN51679511
Research summary
Oesophageal adenocarcinoma (OAC) is a type of cancer found in the food pipe (oesophagus). Despite improvements in treatments, more half of people diagnosed with OAC don't survive more than 5 years after diagnosis (although this improves when diagnosed early and if the patient is younger and fit). Currently, if OAC is thought to be 'potentially curative' at diagnosis, patients will undergo chemotherapy (termed ‘FLOT’) or chemoradiotherapy (mixture of chemo- and radiotherapy, termed ‘CROSS’) to shrink the tumour before it is surgically removed.
With FLOT, patients undergo four cycles of chemotherapy before surgery and four more cycles after. Patients undergoing CROSS receive a mixture of chemotherapy with radiotherapy before surgery and sometimes immunotherapy to help the immune system to fight any remaining cancer.
Completing either of these provides the best chance at living cancer-free after surgery, however, this can be challenging and less than half of people undergoing chemotherapy after surgery complete all four cycles.
Pressures during the COVID-19 pandemic meant that some people with OAC had all their chemotherapy before surgery (termed ‘total neoadjuvant treatment’ or ‘TNT’), and many of these individuals are living cancer-free more than 5 years on. We want to find out if this method of delivering FLOT (FLOT-TNT) or some FLOT (four cycles) with CROSS (FLOT-CROSS) offers patients with OAC a better chance of completing treatment compared with current FLOT regimens.
To do this, we will be recruiting individuals with newly diagnosed ‘potentially curable’ OAC to our trial and randomly (by chance) allocating them to one of the three treatment arms (FLOT-TNT, FLOT-CROSS or standard FLOT). We will compare how well they tolerate their treatment and how they progress through surgery and beyond. Results of this study will help us determine whether a larger trial should be carried out to see which of these treatment options should become standard of care for OAC.REC name
Wales REC 5
REC reference
26/WA/0082
Date of REC Opinion
13 May 2026
REC opinion
Further Information Favourable Opinion