Individualized Tumor Response Testing for Prediction of Response to Paclitaxel and Cisplatin Chemotherapy in Patients with Advanced Gastric Cancer

Introduction. A multimodal approach to the treatment of locally advanced gastric cancer with the addition of systemic or local treatment methods, such as chemotherapy and radiation therapy, reduces the risk of cancer recurrence, thus improving survival of patients. Advances in anticancer therapy dictate the need to develop systems for assessing tumor response to new treatment modalities.Material and Methods. The study included 162 patients with locally advanced gastric cancer who received treatment at the N.N. Petrov National Medical Research Center of Oncology from 2015 to 2018. All patients underwent subtotal gastric resection or gastrectomy with lymph node dissection and previously received neoadjuvant polychemotherapy. Patients were in the age range 30 to 80 years old. The tumor pathomorphological response to chemotherapy was assessed in all patients using a pathomorphological response rate system according to the classification of the Japanese Gastric Cancer Association (JGCA, 3rd English edition). All patients underwent computed tomography with pneumogastrography before neoadjuvant chemotherapy and immediately before surgery. For each of 162 patients, 96 qualitative and quantitative biomarkers of tumor and paragastric lymph node imaging were analyzed.Results. The accuracy of determining the tumor response rate using computed tomography with pneumogastrography was 82.6 % for TRG-0/1, 90 % for TRG-1/2, and 88 % for TRG-2/3. Discussion. The tumor pathomorphological response to treatment is a predictor of long-term results; however, it can be assessed only after analyzing the surgical specimen, and this marker cannot be used in inoperable cases and for correction of palliative chemotherapy. The study of imaging biomarkers based on quantitative and qualitative data reflecting the histopathological features of the tumor and lymph nodes can help determine the tumor regression grade and optimize treatment.Conclusion. The proposed algorithm for assessing the response grade of locally advanced gastric cancer to chemotherapy using imaging biomarkers is a promising prognostic marker and requires further study.

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Prediction of Response to 5′-Deoxy- 5-Fluorouridine (5′-DFUR) in Patients with Inoperable Advanced Gastric Cancer by Immunostaining of Thymidine Phosphorylase/Platelet-Derived Endothelial Cell Growth Factor

Oncology ◽

10.1159/000011968 ◽

1999 ◽

Vol 56 (3) ◽

pp. 215-222 ◽

Cited By ~ 25

Author(s):

Wasaburo Koizumi ◽

Katsunori Saigenji ◽

Naomi Nakamaru ◽

Isao Okayasu ◽

Minoru Kurihara

Keyword(s):

Gastric Cancer ◽

Endothelial Cell ◽

Growth Factor ◽

Cell Growth ◽

Advanced Gastric Cancer ◽

Thymidine Phosphorylase ◽

Prediction Of Response ◽

Endothelial Cell Growth Factor ◽

Endothelial Cell Growth

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Prognostic value of response assessed by RECIST and WHO criteria to neoadjuvant chemotherapy in locally advanced gastric cancer patients

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15647 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15647-e15647

Author(s):

S. R. Park ◽

J. S. Lee ◽

Y. W. Kim ◽

I. J. Choi ◽

K. W. Ryu ◽

...

Keyword(s):

Gastric Cancer ◽

Neoadjuvant Chemotherapy ◽

Advanced Gastric Cancer ◽

Tumor Size ◽

Tumor Response ◽

Locally Advanced ◽

R0 Resection ◽

Who Criteria ◽

Locally Advanced Gastric Cancer ◽

Response To Neoadjuvant Chemotherapy

e15647 Background: In metastatic gastric cancer, the response to chemotherapy is assessed by RECIST or WHO criteria according to the change of tumor size. There are no data, however, on the usefulness of those criteria in evaluating tumor response in the setting of neoadjuvant chemotherapy. The aim of this study was to evaluate the relationship between tumor response to neoadjuvant chemotherapy-as assessed by RECIST and WHO criteria-and clinical outcome in locally advanced gastric cancer (LAGC) patients. Methods: This study recruited LAGC patients who, from January 2003 through November 2005, entered the neoadjuvant arm of prospective randomized phase II trials comparing neoadjuvant chemotherapy to adjuvant chemotherapy. LAGC was defined as stage III or IV (M0) disease based on computed tomography (CT) according to the Japanese Classification of Gastric Carcinoma. Patients with measurable lesions received 3 cycles of neoadjuvant chemotherapy consisting of docetaxel (36 mg/m2) and cisplatin (40 mg/m2) on days 1 and 8 every 3 weeks, followed by surgery. Results: After chemotherapy, 40 (95%) patients underwent surgery and the remaining 2 patients showed new distant metastasis on CT scan. Thirty-five (83%) patients had curative R0 resection. Twenty-eight (67%) patients had a clinical response to neoadjuvant chemotherapy according to RECIST/WHO criteria. Although R0 resection rate (93% vs 64%, P = 0.03), median relapse-free survival (RFS) (43.2 vs 7.5 months, P = 0.14), and overall survival (OS) (not reached vs 27.0 months, P = 0.10) were better in responders than non-responders, they did not differ significantly in the subgroup that subsequently underwent surgery. When we redefined the decrease in tumor size judged as a response by RECIST (≥60% rather than ≥30%) and WHO (≥75% rather than ≥50%) criteria, response correlated significantly with both RFS (P = 0.03) and OS (P = 0.02). Conclusions: In the neoadjuvant setting, which frequently involves smaller measurable lesions than the metastatic setting, larger changes in tumor size than those specified by RECIST and WHO criteria are needed to predict postoperative outcome. No significant financial relationships to disclose.

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Predictors of pathological response and tumor regression following neoadjuvant therapy in advanced gastric cancer patients.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.4_suppl.206 ◽

2017 ◽

Vol 35 (4_suppl) ◽

pp. 206-206 ◽

Cited By ~ 1

Author(s):

Ulysses Ribeiro ◽

Marcus Fernando Kodama Pertille Ramos ◽

Marina Alessandra Pereira ◽

André Roncon Dias ◽

Osmar Kenji Yagi ◽

...

Keyword(s):

Gastric Cancer ◽

Lymph Node ◽

Advanced Gastric Cancer ◽

Tumor Response ◽

Tumor Regression ◽

Clinicopathological Characteristics ◽

R0 Resection ◽

Histopathological Response ◽

Neutrophil Lymphocyte Ratio ◽

Significant Difference

206 Background: Neoadjuvant chemotherapy (NACT) has became the standard approach for patients with advanced gastric cancer. Clinicopathological characteristics can be utilized to evaluate the effect of NACT, and may be a useful tool to identify responsive patients. Methods: We retrospectively reviewed all patients with GC treated with NACT and R0 resection between 2009 and 2015 from a prospective collected database. Histopathological response to the treatment was graded from 0% to 100% and the clinicopathological characteristics assessed to identify predictors of tumor response. A threshold of 50% histopathological response was used for the analysis. Results: NACT was performed in 45 patients. Cisplatin-irinotecan therapy was used in 64.4% of patients and 11 (24.4%) tumors were located in the proximal stomach. Ten (22.2%) patients demonstrated a tumor regression of at least 50% and one patient had complete response. The mean number of lymph node retrieved was 38.1 and 66.7% patients had lymph node metastasis (LNM). Factors associated with > 50% of response by univariate analyses included lower neutrophil-lymphocyte ratio (NLR) ( p = 0.035), diffuse/mixed Lauren type ( p = 0.007), lower depth of tumor invasion ( p = 0.043) and non cisplatin-irinotecan therapy (p = 0.01). A slight tendency of poorly differentiated tumors respond better to NACT than differentiated type was observed ( p = 0.05). There was no significant difference regarding the presence of mucin, calcification and/or necrosis and the tumor response. Multivariate analysis identified NLR and diffuse/mixed tumors as independent predictors of pathologic response. Median follow-up for all patients was 26.5 months and recurrence-free survival (RFS) rate was 74.3% and 60% for patients with > 50% and < 50% of response, respectively ( p= 0.08). RFS was significantly different in patients without LNM compared to patients who have LNM (100% vs. 55.2%, p = 0.01), and in patients with fibroinflammatory/inflammatory stroma infiltration compared to patients with only fibrotic stroma (80% vs. 53.3%, p = 0.015). Conclusions: Diffuse/mixed histopathological type and lower NLR are independently predictors of tumor response after NACT.

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