scholarly journals Current status of perioperative chemotherapy for locally advanced gastric cancer and JCOG perspectives

2020 ◽  
Vol 50 (5) ◽  
pp. 528-534 ◽  
Author(s):  
Masanori Terashima ◽  
Takaki Yoshikawa ◽  
Narikazu Boku ◽  
Seiji Ito ◽  
Akira Tsuburaya ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Stage Ii ◽  
Clinical Staging ◽  
Current Status ◽  
Perioperative Chemotherapy ◽  
Western Countries ◽  
Locally Advanced Gastric Cancer

Abstract Perioperative treatment for locally advanced gastric cancer has been inconsistent between Japan and the Western countries. In Japan, D2 gastrectomy followed by adjuvant chemotherapy is regarded as standard treatment, while neoadjuvant or perioperative chemotherapy is considered to be a standard in the Western countries. Stomach Cancer Study Group of Japan Clinical Oncology Group (JCOG) has conducted many perioperative chemotherapy trials. After the publishing of positive results of ACTS-GC trial, stage-specific adjuvant chemotherapy protocols are planned. JCOG1104 was conducted as to demonstrate the non-inferiority of four courses of S-1 to standard eight courses of S-1, because the efficacy of S-1 appears to be sufficient in stage II. The trial failed to demonstrate the non-inferiority of four courses of S-1. S-1 for 1 year is still recognized to be a standard for stage II gastric cancer. For stage III, studies with more intensive treatments were planned as the efficacy of S-1 monotherapy seems to be insufficient. As in the Western countries, JCOG planned the perioperative chemotherapy. However, the clinical staging is a serious issue to select optimal patients for perioperative chemotherapy. JCOG conducted a prospective cohort study to evaluate the validity of clinical staging in JCOG1302A. From the results of this study, cT3-4 and cN1–3 are selected as optimal candidate for perioperative chemotherapy. JCOG1509 was conducted to demonstrate the superiority of perioperative chemotherapy to adjuvant chemotherapy in these cohorts. Perioperative chemotherapy for marginally resectable tumours such as linitis plastica or extensive nodal disease and special type of cancer like HER2 positive are also conducted.

scholarly journals Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives

Surgery Today ◽  
2019 ◽  
Vol 50 (1) ◽  
pp. 30-37 ◽  
Author(s):  
Masanori Tokunaga ◽  
Yuya Sato ◽  
Masatoshi Nakagawa ◽  
Tomoki Aburatani ◽  
Takatoshi Matsuyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Neoadjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Randomized Clinical Trials ◽  
Standard Treatment ◽  
Locally Advanced ◽  
Adjuvant Chemoradiotherapy ◽  
Perioperative Chemotherapy ◽  
Locally Advanced Gastric Cancer

Abstract The standard treatment for locally advanced gastric cancer differs across the world. In western countries, perioperative chemotherapy or postoperative adjuvant chemoradiotherapy are the preferred treatment options, whereas in Asia, D2 gastrectomy followed by postoperative adjuvant chemotherapy is standard. In Japan, adjuvant chemotherapy with S-1 is the standard treatment for pStage II gastric cancer, whereas adjuvant chemotherapy with a doublet regimen is preferred for pStage III gastric cancer. The efficacy of preoperative neoadjuvant chemotherapy using S-1 plus cisplatin, has been investigated in selected patients with expected poor survival outcomes. To expand the indications for neoadjuvant chemotherapy, a clinical trial investigating the efficacy of preoperative S-1 plus oxaliplatin in patients with cStage III (cT3-4N1-3) gastric cancer (JCOG1509) is ongoing in Japan. The addition of immune checkpoint inhibitors to cytotoxic chemotherapy also seems promising and is being investigated in international randomized clinical trials. Although we have to await the final results of these studies, preoperative neoadjuvant chemotherapy is a promising treatment strategy and likely to become standard treatment for locally advanced gastric cancer in Japan.

scholarly journals Correction to: Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives

Surgery Today ◽  
2020 ◽  
Vol 50 (4) ◽  
pp. 424-424
Author(s):  
Masanori Tokunaga ◽  
Yuya Sato ◽  
Masatoshi Nakagawa ◽  
Tomoki Aburatani ◽  
Takatoshi Matsuyama ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Open Access ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Perioperative Chemotherapy ◽  
Future Perspectives ◽  
Locally Advanced Gastric Cancer

The article Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives, written by Masanori Tokunaga, Yuya Sato, Masatoshi Nakagawa, Tomoki Aburatani, Takatoshi Matsuyama, Yasuaki Nakajima and Yusuke Kinugasa was originally published Online First without Open Access.

Evaluation of the effectiveness of adjuvant chemotherapy for locally advanced gastric cancer in real clinical practice

Pharmateca ◽  
2020 ◽  
Vol 7_2020 ◽  
pp. 41-45
Author(s):  
N.P. Belyak Belyak ◽  
R.V. Orlova Orlova ◽  
S.I. Kutukova Kutukova ◽  
N.V. Zhukova Zhukova ◽  
S.A. Borozdina Borozdina ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Clinical Practice ◽  
Adjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Locally Advanced ◽  
Locally Advanced Gastric Cancer ◽  
Real Clinical Practice

scholarly journals Duration of Perioperative Chemotherapy in Locally Advanced Gastric Cancer: A “Less Is More” Question When ypN0 Is Achieved

2021 ◽  
Vol 11 ◽  
Author(s):  
Zining Liu ◽  
Yinkui Wang ◽  
Fei Shan ◽  
Xiangji Ying ◽  
Yan Zhang ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Advanced Gastric Cancer ◽  
Cox Regression ◽  
Locally Advanced ◽  
R0 Resection ◽  
Perioperative Chemotherapy ◽  
Tree Model ◽  
Less Is More ◽  
Locally Advanced Gastric Cancer ◽  
Significant Difference

BackgroundsPerioperative chemotherapy (PEC) and neoadjuvant chemotherapy (NAC) have become a vital part of locally advanced gastric cancer (LAGC) treatment, but the optimal duration of PEC has not been studied. The aim of this study was to demonstrate the possibility of duration reduction in PEC in the adjuvant chemotherapy (AC) phase for ypN0 patients.MethodsWe included LAGC patients who achieved ypN0 after NAC in our institution from 2005 to 2018. The risk/benefit of AC and other covariates were majorly measured by overall survival (OS) and progression-free survival (PFS). We developed a survival-tree-based model to determine the optimal PEC duration for ypN0 patients in different classes.ResultsA total of 267 R0 resection patients were included. There were 55 patients who did not receive AC. The 5-year OS was 74.34% in the non-AC group and 83.64% in the AC group with a significant difference (p = 0.012). Multivariate Cox regression revealed that both AC (AC vs. non-AC: HR, 0.49; 95%CI, 0.27–0.88; p = 0.018) and ypT stages (ypT3-4 vs. ypT0-2: HR, 2.00; 95%CI, 1.11–3.59; p = 0.021) were significant protective/risk factors on patients OS and PFS. A decision tree model for OS indicated an optimal four to six cycles of PEC, which was recommended for ypT0-2N0 patients, while a minimum of five PEC cycles was recommended for ypT3-4N0 patients.ConclusionAC treatment is still necessary for ypN0. The duration reduction could be applied for the ypT0-2N0 stage patients but may not be suitable for higher ypT stages and beyond. A multicenter-based study is required.

Randomized trial of adjuvant chemotherapy with mitomycin plus ftorafur versus mitomycin alone in resected locally advanced gastric cancer.

1998 ◽  
Vol 16 (3) ◽  
pp. 1036-1039 ◽  
Author(s):  
J J Grau ◽  
J Estapé ◽  
J Fuster ◽  
X Filella ◽  
J Visa ◽  
...  
Keyword(s):  
Gastric Cancer ◽  
Adjuvant Chemotherapy ◽  
Advanced Gastric Cancer ◽  
Early Stage ◽  
Locally Advanced ◽  
Survival Rates ◽  
Group Versus ◽  
Node Negative ◽  
Treatment Groups ◽  
Locally Advanced Gastric Cancer

PURPOSE We performed a clinical trial to determine whether postoperative adjuvant chemotherapy with two drugs versus one drug could prolong survival. PATIENTS AND METHODS From 1985 to 1996, 85 patients with completely resected locally advanced gastric cancer were enrolled. The subjects were randomized into two treatment groups, as follows: mitomycin (MMC) 10 to 20 mg/m2 intravenously (i.v.) on day 1 every 6 weeks plus ftorafur (FT) 500 mg/m2/d for 36 consecutive days; or MMC alone, 10 to 20 mg/m2 i.v. every 6 weeks. All courses were repeated four times. RESULTS After a median follow-up duration of 62 months, the overall 5-year survival rates were 67% for the MMC-FT group versus 44% for the MMC group (P = .04). Subgroup analysis to compare survival curves using the method of Mantel-Cox showed survival rates significantly in favor of the MMC-FT group in the subsets of patients with node-negative disease (P = .01) and those whose disease was stage IB or II (P = .008). CONCLUSION Significantly better survival results were observed for MMC-FT versus MMC alone. Subset analysis suggest a strong benefit in patients with node-negative and early-stage resected gastric cancer.

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