Could a $4 statin improve cancer survival?

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: 1. Signed, informed consent. 2. Age, 18 years or older. 3. Histological diagnosis of adenocarcinoma or poorly differentiated carcinoma of the esophagus or EGJ. 4. The tumour must be deemed potentially resectable by the surgical team. This assessment is based on complete staging imaging studies (detailed below) - clinical staging of the tumor and ruling out metastatic disease. 5. Locally advanced disease as defined per AJCC/UICC 8th edition37: stage IIA, IIB, III, IVA (T1-4a N2-3). 6. Eligibility for standard-of-care perioperative systemic therapy with FLOT+/-D. 7. Life expectancy greater than 3 months. 8. ECOG performance status \< 2. Exclusion Criteria: 1. Prior esophageal or gastric malignancy. 2. History of allergic reactions to simvastatin or atorvastatin or similar chemical or biological compounds. 3. Ongoing cholesterol-lowering therapy (statins, fibrates, ezetimibe, PCSK9 inhibitors), in which case the patient is offered enrollment in the observational arm. 4. Hepatic dysfunction (alanine aminotransferase level more than three times the upper limit of the normal range) or renal dysfunction (creatinine level more than three times the upper limit of the normal range). 5. Predisposing factors for rhabdomyolysis: hypothyroidism, reduced renal function, muscle disease, or excessive alcohol consumption AND creatine kinase up to less than five times the upper limit (measured in the presence of predisposing factors). 6. Concurrent medication with potent CYP3A4-inhibitors, e.g. ketokonazole, erythromycin, gemfibrozil, cyclosporine, or danazol. 7. Pre-existing medical conditions precluding treatment, including any contraindication systemic chemotherapy or major surgery. 8. Psychological, familial, sociological or geographical condition potentially hampering compliance with the study protocol and follow-up schedule, discussed before registration in the trial. 9. Pregnant and breastfeeding women. 10. Unwillingness to undergo per-protocol investigations or treatments.