Effect of two neoadjuvant chemotherapy regimens on short-term curative effect, radical resection rate and survival time of patients with advanced gastric cancer

TPS180 Background: Prognosis for locally advanced gastric cancer, such as clinical T4 disease, bulky nodal involvement, type 4 and large type 3 gastric cancer, was not satisfactory even by D2 gastrectomy followed by adjuvant chemotherapy. Neoadjuvant chemotherapy is another promising approach. In our phase I study, neoadjuvant chemotherapy of S-1 and oxaliplatin (SOX) had manageable toxicities and good pathological complete response rate (33%) in patients with locally advanced gastric cancer. Based on the results of this phase I study, we initiate a multi-institutional, single-arm, open label, phase II study (Neo G-SOX PII study). The aim of this study is to evaluate the efﬁcacy and safety of the neoadjuvant chemotherapy of S-1 and oxaliplatin (SOX) followed by gastrectomy with D2/3 lymph node dissection; clinical T4; clinically resectable gastric cancer of type 4 or large type 3 (over 8 cm); bulky nodal involvement around major branched arteries to the stomach Methods: Eligibility criteria include histologically proven adenocarcinoma of the stomach; clinical T4; clinically resectable gastric cancer of type 4 or large type 3 (over 8 cm); bulky nodal involvement around major branched arteries to the stomach; resectable peritoneal dissemination (pathological CY1 or P1, except for clinical CY1 or P1). Patients receive two cycles of neoadjuvant chemotherapy with S-1 (80 mg/m2, p.o., days 1-14 followed by 1 week rest) and oxaliplatin (130 mg/m2 at day 1), followed by D2 or higher surgery with no residual disease. Patients with pathological R0/1 resection received S-1 (80 mg/m2, p.o., days 1-28 followed by 2 week rest) for 1 year as adjuvant chemotherapy. Primary endpoint is curative resection rate. Key secondary endpoints include pathological response, R0/1 resection rate, dose-intensity, overall survival, relapse free survival and safety. We set the threshold curative resection rate at 65% and the expected curative resection rate at 80%. Given a one-sided α of 0.1 and statistical power of 80%, 40 patients was required. Clinical trial information: UMIN000018661 Clinical trial information: UMIN000018661.

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Recent Advances in the Diagnosis, Staging, Treatment, and Prognosis of Advanced Gastric Cancer: A Literature Review

Frontiers in Medicine ◽

10.3389/fmed.2021.744839 ◽

2021 ◽

Vol 8 ◽

Author(s):

Zhi-da Chen ◽

Peng-fei Zhang ◽

Hong-qing Xi ◽

Bo Wei ◽

Lin Chen ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Malignant Tumors ◽

Treatment Options ◽

Survival Rates ◽

Radical Resection ◽

Recent Advances ◽

Drug Choice ◽

Advanced Stages

Gastric cancer is one of the most common cause of cancer related deaths worldwide which results in malignant tumors in the digestive tract. The only radical treatment option available is surgical resection. Recently, the implementation of neoadjuvant chemotherapy resulted in 5-year survival rates of 95% for early gastric cancer. The main reason of treatment failure is that early diagnosis is minimal, with many patients presenting advanced stages. Hence, the greatest benefit of radical resection is missed. Consequently, the main therapeutic approach for advanced gastric cancer is combined surgery with neoadjuvant chemotherapy, targeted therapy, or immunotherapy. In this review, we will discuss the various treatment options for advanced gastric cancer. Clinical practice and clinical research is the most practical way of reaching new advents in terms of patients' characteristics, optimum drug choice, and better prognosis. With the recent advances in gastric cancer diagnosis, staging, treatment, and prognosis, we are evident that the improvement of survival in this patient population is just a matter of time.

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The Safety and Efficacy of Laparoscopic Gastrectomy for Patients with Locally Advanced Gastric Cancer Following Neoadjuvant Chemotherapy

10.21203/rs.3.rs-47635/v1 ◽

2020 ◽

Author(s):

Lihang Liu ◽

Feng Li ◽

Shengtao Lin ◽

Yi Liu ◽

Changshun Yang ◽

...

Keyword(s):

Gastric Cancer ◽

Postoperative Complications ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Laparoscopic Gastrectomy ◽

Locally Advanced ◽

R0 Resection ◽

Resection Rate ◽

Locally Advanced Gastric Cancer ◽

Significant Difference

Abstract Background: Limited researches focused on the application of laparoscopic gastrectomy (LG) in locally advanced gastric cancer (LAGC) patients following neoadjuvant chemotherapy (NACT). In this study, we aimed at illustrating the surgical and survival outcome of LG in LAGC patients following NACT.Methods: We performed a retrospective study of patients with LAGC who received either LG following NACT or upfront LG at Fujian Provincial Hospital between March 2013 and October 2018. Perioperative parameters, short-term and long-term outcomes were compared. The Kaplan-Meier estimator was used to describe the survival curves, and the differences were examined by the log-rank test.Results: In total, 76 consecutive patients were enrolled into the NACT-LG (41 patients) and LG (35 patients) group, respectively. There was no significant difference between the two groups for baseline characteristics, including age, sex, BMI, Eastern Clinical Oncology Group performance status, tumor size, location, Borrmann type, Lauren type, differentiation, cT stage, and surgical type (all P>0.05). The surgical trauma in terms of incision length and blood loss, and postoperative recovery in terms of first aerofluxus time, first time on liquid diets, drainage duration, and hospital stays were similar between the two groups (all P>0.05). The operation time was significantly longer for NACT-LG than for LG (286.5 vs. 248.9 min, P=0.008). There was no significant difference in surgical morbidity (19.5% vs. 22.9%, P=0.721) between the two groups. No patient died of postoperative complications in the NACT-LG group, and one patient (1/35, 2.9%) died of postoperative complications in the LG group (P=0.461). After NACT, the R0 resection rate was significantly higher (95.1% vs. 77.1%, P=0.049), and metastatic lymph nodes were less for NACT-LG than for LG (1 vs. 8, P=0.001). Compared with the LG group, the NACT-LG group had a significantly better DFS (59.4% vs. 14.4%, P=0.034) and better OS (69.0% vs. 37.4%, P=0.009) at 3 years.Conclusions: NACT does not decrease safety of LG for patients with LAGC and offer higher R0 resection rate and better disease-free and overall survival. For patients with LAGC, LG following NACT should be the priority treatment.

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Safety and efficacy of neoadjuvant chemotherapy with S-1 and oxaliplatin plus apatinib for locally advanced gastric cancer.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e15503 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e15503-e15503

Author(s):

Ya'nan Zheng ◽

Xiao Yang ◽

Zhentian Ni ◽

Zhenglun Zhu ◽

Wei Xu ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Neoadjuvant Therapy ◽

Advanced Gastric Cancer ◽

Locally Advanced ◽

R0 Resection ◽

Resection Rate ◽

Surgical Morbidity ◽

Safety And Efficacy ◽

Locally Advanced Gastric Cancer

e15503 Background: Locally advanced gastric cancer (LAGC) has a poor prognosis. Neoadjuvant chemotherapy can reduce tumor loading, degrade staging and increase possibility of complete resection, thus prolonging the survival of LAGC patients (pts). We conducted a phase II trial to assess the feasibility of SOX regimen in combination with apatinib (an anti-angiogenic agent) as neoadjuvant therapy in LAGC. Methods: This study recruited untreated LAGC pts with pathologically and/or cytologically confirmed adenocarcinoma. Treatment included three 21-day cycles of apatinib (oral, 500 mg qd; discontinued in the last cycle), S-1 (oral, 40-60 mg, bid, day 1-day 14) and oxaliplatin (iv, 130 mg/m2, day 1), followed by radical surgery after 4 weeks. The primary outcome was neoadjuvant therapy related toxicity, and the secondary outcomes included tumor response, R0 resection rate, postoperative pathological evaluation and surgical morbidity. Results: Between December 2, 2016 and August 1, 2018, 31 patients were enrolled. Total 29 patients were eligible for safety and efficacy analyses of SOXA as NAC. During NAC treatment, the incidence of adverse events (AEs, any grade) was 100%, and the incidence of grade 3/4 AEs was 34.48%. No treatment-related death. The ORR of 79.31% (95%CI, 60.28-92.01%) and DCR of 96.55% (95%CI, 82.24-99.91%) were achieved. One patient was evaluated as PD with hepatic metastasis after 3 cycles of preoperative chemotherapy, and this case was inoperable. Resection with curative intent was undertaken in 28 patients with R0 resection rate of 100%. Operative morbidity was observed in 12 of 28 patients including fever (9, 32.14%), anastomotic leakage (1, 3.57%), fat liquefaction of post-surgical incision (1, 3.57%), and gastroparesis (1, 3.57%). Additionally, after surgery 1 patient had pulmonary infection and 1 patient had pleural effusion. The median tumor regression was 90% on pathological findings after surgery. Conclusions: Neoadjuvant therapy with apatinib plus SOX for LAGC showed acceptable toxicity and promising efficacy.

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Nomogram for predicting survival in advanced gastric cancer after neoadjuvant chemotherapy and radical surgery

10.21203/rs.3.rs-46932/v1 ◽

2020 ◽

Author(s):

Yonghe Chen ◽

Dan Liu ◽

Jian Xiao ◽

Jun Xiang ◽

Aihong Liu ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Chemotherapy ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Cox Regression ◽

Radical Surgery ◽

Survival Rates ◽

Radical Resection ◽

R0 Resection ◽

Clinical Parameters

Abstract BACKGROUND Neoadjuvant chemotherapy (NAC) with subsequent radical surgery has become a popular treatment modality for advanced gastric cancer (AGC) worldwide. However, the survival benefit is still controversial, and prognostic factors remain undetermined. AIM To identify clinical parameters that are associated with the survival of AGC patients after NAC and radical surgery and to establish a nomogram integrating multiple factors to predict survival. METHODS We reviewed the medical profiles of 215 AGC patients who received NAC and radical resection, and clinical parameters concerning NAC, surgery, pathological findings, and adjuvant chemotherapy were analyzed using a Cox regression model to determine their impact on survival. Based on these factors, a nomogram was developed and validated. RESULTS The overall 1-year and 3-year survival rates were 85.8% and 55.6%, respectively. Younger age (< 60 years old), increased examined lymph nodes (exLNs), successful R0 resection, achievement of pathological complete response (pCR), and acceptance of adjuvant chemotherapy were positive predictors of survival. The concordance statistic of the established nomogram was 0.785. The model showed an ideal calibration following internal bootstrap validation. CONCLUSION A nomogram predicting survival after NAC and surgery was established. Since this nomogram exhibited satisfactory and stable predictive power, it can be inferred that this it is a practical tool for predicting AGC patient survival after NAC and radical surgery.

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