1391P Clinical progress in inoperable or recurrent advanced gastric cancer treatment from 1,004 single institute experiences between 2007 and 2018

Fluoropyrimidines have shown efficacy against a variety of cancers and have evolved into a range of different uses and formulations. These drugs have been tested extensively as monotherapies and as part of numerous different chemotherapy combinations. The efficacy and safety profile of bolus intravenous (IV) 5-fluorouracil (5-FU) has been improved by continuous IV administration. The availability of the first 5-FU oral form in Europe, capecitabine, has added a clear value in terms of convenience for patients, while forcing physicians and nurses to learn how to manage the toxicity profile of this compound. S-1 is a new oral formulation combining a 5-FU prodrug (tegafur) and two targeted modulators of its metabolism (gimeracil and oteracil) preserving the efficacy and improving the safety of the prodrug. S-1 has become the backbone treatment for advanced gastric cancer in Japan since its introduction in 1999. Extensive experience from clinical trials, post-marketing studies and patient registries of over 4,000 patients in Japan show that S-1 has improved measures of survival in advanced gastric cancer and has an acceptable safety profile. S-1 has recently been approved for advanced gastric cancer treatment in Europe. Since 5-FU metabolism differs between Asian and Caucasian populations, the introduction of S-1 in Caucasians has necessitated an entirely new clinical trial programme. Phase I trials indicated different dose levels were necessary in Westerners versus Asians (25 versus 40 mg/m2). In the FLAGS study of over 1,000 patients with advanced gastric cancer (the largest study ever conducted in this indication), S-1 plus cisplatin was demonstrated to be non-inferior in efficacy but superior in safety to 5-FU + cisplatin. Based on these results, S-1 was approved in Europe in March 2011 under the trade name Teysuno®. Further clinical trials are in progress to evaluate S-1 in advanced gastric cancer (AGC) and its use as part of triplet therapies is currently being investigated. This will further define the role of S-1 as a key part of advanced gastric cancer management in Western countries.

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A survey of early and advanced gastric cancer treatment by surgeons in Thailand

Oncology Reviews ◽

10.4081/oncol.2018.369 ◽

2018 ◽

Author(s):

Prasit Mahawongkajit ◽

Prakitpunthu Tomtitchong

Keyword(s):

Gastric Cancer ◽

Cancer Treatment ◽

Advanced Gastric Cancer ◽

Open Surgery ◽

Demographic Data ◽

Treatment Options ◽

En Bloc Resection ◽

En Bloc ◽

Gastric Cancer Treatment ◽

Current Practices

This study shows the first survey of patterns about surgeons’ approaches and current practices in early and advanced gastric cancer in Thailand. Gastric cancer is a significant health problem worldwide. International guidelines for treatment differ in their recommendations including the accompanying therapy, but the condition is potentially curable. Surgeons have played an important role in Thailand but the limitation of institutional resources and the practices for gastric cancer vary between treatment options. The aim of this study is to investigate the current practices and approaches of Thai surgeons in relation to early and advanced gastric cancer treatment. A survey was conducted on 112 surgeons who claimed to have performed clinical practice upon gastric cancer patients. Information was collected on participant demographic data, the practices approaches in early and advanced stage without metastasis and the preferable adjuvant chemotherapy. The majority of participants were 100 general surgeons (89.4%). The preferred early gastric cancer treatment proved to be endoscopic resection 83.9%, cT1bN0 group preferred laparoscopic surgery 75.9%, cT2-T4aN0 group preferred open surgery 67.8%, cT4bN0 group preferred open surgery with En bloc resection 85.7% and cN+ group preferred open surgery 70.5%. For adjuvant treatment with chemotherapy, the study showed the surgeons who prescribed and treated by themselves was 41.9%. The preferred adjuvant regimens were S-1 50.9% and capecitabine and oxaliplatin 31.3%. This study is the first survey of the patterns of surgeons’ approaches and current practices in early and advanced gastric cancer in Thailand.

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