Patrick Forde

When we presented data from all the neoadjuvant/periop IO studies people were understandably concerned about what happened to those who didn’t get operated. People were also confused by the stage overlap between PACIFIC and the surgical trials. So the goal of MDT-BRIDGE was to better understand these gaps and evaluate whether an early MDT reassessment after 2 cycles could allow most patients to achieve definitive locoregional control, which they did in 95% of cases. MDT reassessment also enabled very high R0 rates. Complication profile for the CRT group seemed reasonable as well which was another gap in knowledge. The goal wasn’t AT ALL to compare the survival outcomes between the two forms of locoregional therapy. Our intent was to bring data to areas of uncertainty after multiple phase 3 trials. We also wished to understand why MDTs might interpret resectability differently and this work is still ongoing. The data are also not meant to be used to justify a trial. Before such an RCT could be done, I think the Rad Onc community would have to prove that neoadj chemoIO followed by CRT is superior or at least equivalent to PACIFIC. Once this is done, we can talk about the RCT… still much work to be done.