Perioperative Treatment in Resectable Gastric Cancer: Current Perspectives and Future Directions

Gastric cancer (GC) is the fifth-most common cancer worldwide and an important cause of cancer-related-death. The growing knowledge of its molecular pathogenesis has shown that GC is not a single entity, but a constellation of different diseases, each with its own molecular and clinical characteristics. Currently, surgery represents the only curative approach for localized GC, but only 20% of patients (pts) showed resectable disease at diagnosis and, even in case of curative resection, the prognosis remains poor due to the high rate of disease relapse. In this context, multimodal perioperative approaches were developed in western and eastern countries in order to decrease relapse rates and improve survival. However, there is little consensus about the optimal treatment for non-metastatic GC. In this review, we summarize the current status and future developments of perioperative chemotherapy in resectable GC, attempting to find clear answers to the real problems in clinical practice.

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Surgical treatment of gastric cancer: Current status and future directions

Chinese Journal of Cancer Research ◽

10.21147/j.issn.1000-9604.2021.02.04 ◽

2021 ◽

Vol 33 (2) ◽

pp. 159-167

Author(s):

Jiahui Chen ◽

◽

Zhaode Bu ◽

Jiafu Ji

Keyword(s):

Gastric Cancer ◽

Surgical Treatment ◽

Current Status ◽

Future Directions

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Towards Personalization in the Curative Treatment of Gastric Cancer

Frontiers in Oncology ◽

10.3389/fonc.2020.614907 ◽

2020 ◽

Vol 10 ◽

Author(s):

Astrid E. Slagter ◽

Marieke A. Vollebergh ◽

Edwin P. M. Jansen ◽

Johanna W. van Sandick ◽

Annemieke Cats ◽

...

Keyword(s):

Gastric Cancer ◽

Treatment Options ◽

Treatment Strategies ◽

Standard Of Care ◽

Molecular Characteristics ◽

Perioperative Chemotherapy ◽

Current Standard ◽

Common Cancer ◽

Resectable Gastric Cancer

Gastric cancer is the fifth most common cancer worldwide and has a high mortality rate. In the last decades, treatment strategy has shifted from an exclusive surgical approach to a multidisciplinary strategy. Treatment options for patients with resectable gastric cancer as recommended by different worldwide guidelines, include perioperative chemotherapy, pre- or postoperative chemoradiotherapy and postoperative chemotherapy. Although gastric cancer is a heterogeneous disease with respect to patient-, tumor-, and molecular characteristics, the current standard of care is still according to a one-size-fits-all approach. In this review, we discuss the background of the different treatment strategies in resectable gastric cancer including the current standard, the specific role of radiotherapy, and describe the current areas of research and potential strategies for personalization of therapy.

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The Efficacy and Safety of (Neo)Adjuvant Therapy for Gastric Cancer: A Network Meta-analysis

Cancers ◽

10.3390/cancers11010080 ◽

2019 ◽

Vol 11 (1) ◽

pp. 80 ◽

Cited By ~ 8

Author(s):

Tom van den Ende ◽

Emil ter Veer ◽

Mélanie Machiels ◽

Rosa Mali ◽

Frank Abe Nijenhuis ◽

...

Keyword(s):

Gastric Cancer ◽

Curative Resection ◽

Meta Analysis ◽

Treatment Strategies ◽

Disease Free Survival ◽

Perioperative Chemotherapy ◽

Curative Intent ◽

Radio Therapy ◽

Credible Intervals ◽

Resectable Gastric Cancer

Background: Alternatives in treatment-strategies exist for resectable gastric cancer. Our aims were: (1) to assess the benefit of perioperative, neoadjuvant and adjuvant treatment-strategies and (2) to determine the optimal adjuvant regimen for gastric cancer treated with curative intent. Methods: PubMed, EMBASE, CENTRAL, and ASCO/ESMO conferences were searched up to August 2017 for randomized-controlled-trials on the curative treatment of resectable gastric cancer. We performed two network-meta-analyses (NMA). NMA-1 compared perioperative, neoadjuvant and adjuvant strategies only if there was a direct comparison. NMA-2 compared different adjuvant chemo(radio)therapy regimens, after curative resection. Overall-survival (OS) and disease-free-survival (DFS) were analyzed using random-effects NMA on the hazard ratio (HR)-scale and calculated as combined HRs and 95% credible intervals (95% CrIs). Results: NMA-1 consisted of 9 direct comparisons between strategies for OS (14 studies, n = 4187 patients). NMA-2 consisted of 16 direct comparisons between adjuvant chemotherapy/chemoradiotherapy regimens for OS (37 studies, n = 10,761) and 14 for DFS (30 studies, n = 9714 patients). Compared to taxane-based-perioperative-chemotherapy, surgery-alone (HR = 0.58, 95% CrI = 0.38–0.91) and perioperative-chemotherapy regimens without a taxane (HR = 0.79, 95% CrI = 0.58–1.15) were inferior in OS. After curative-resection, the doublet oxaliplatin-fluoropyrimidine (for one-year) was the most efficacious adjuvant regimen in OS (HR = 0.47, 95% CrI = 0.28–0.80). Conclusions: For resectable gastric cancer, (1) taxane-based perioperative-chemotherapy was the most promising treatment strategy; and (2) adjuvant oxaliplatin-fluoropyrimidine was the most promising regimen after curative resection. More research is warranted to confirm or reproach these findings.

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Current Status and Future Directions in Gastric Cancer with Peritoneal Dissemination

Surgical Oncology Clinics of North America ◽

10.1016/j.soc.2012.07.002 ◽

2012 ◽

Vol 21 (4) ◽

pp. 625-633 ◽

Cited By ~ 35

Author(s):

Gabriel Glockzin ◽

Pompiliu Piso

Keyword(s):

Gastric Cancer ◽

Peritoneal Dissemination ◽

Current Status ◽

Future Directions

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Perioperative chemotherapy for gastric cancer: the current state

Modern Oncology ◽

10.26442/1815-1434_2018.2.56-60 ◽

2018 ◽

Vol 20 (2) ◽

pp. 56-60

Author(s):

V K Lyadov ◽

O A Pardabekova ◽

M A Lyadova

Keyword(s):

Gastric Cancer ◽

Malignant Tumors ◽

Locally Advanced ◽

High Rate ◽

Phase Iii ◽

Perioperative Chemotherapy ◽

Phase Iii Trial ◽

Locally Advanced Gastric Cancer ◽

Current State ◽

Resectable Gastric Cancer

Gastric cancer has one of the leading positions in the world in the prevalence and mortality among malignant tumors. The results of surgical treatment of locally advanced gastric cancer remain generally poor due to the high rate of relapse after surgery. Currently, perioperative (pre- and postoperative) chemotherapy in combination with surgery is recommended for patients with stage ≥IB resectable gastric cancer. We analyzed the studies devoted to the problem of choosing the optimal regimen of perioperative chemotherapy in locally advanced and oligometastatic gastric cancer. The highest efficacy was observed in the taxan-containing regimen FLOT which allowed to increase the median overall survival up to 50 months in a randomized controlled phase III trial. The use of perioperative chemotherapy with anti-Her2 therapy, immunotherapy or any other biologic drug remains investigational.

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TOPGEAR: An international randomized phase III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer (AGITG/TROG/EORTC/NCIC CTG).

Journal of Clinical Oncology ◽

10.1200/jco.2012.30.15_suppl.tps4141 ◽

2012 ◽

Vol 30 (15_suppl) ◽

pp. TPS4141-TPS4141 ◽

Cited By ~ 12

Author(s):

Trevor Leong ◽

Mark Smithers ◽

Michael Michael ◽

Val Gebski ◽

Alex Boussioutas ◽

...

Keyword(s):

Gastric Cancer ◽

Adjuvant Therapy ◽

Phase Ii ◽

Preoperative Chemotherapy ◽

Gastroesophageal Junction ◽

Phase Iii ◽

Standards Of Care ◽

Current Status ◽

Quality Assurance Program ◽

Resectable Gastric Cancer

TPS4141 Background: Optimal management of patients with resectable gastric cancer remains unknown. Since the INT0116 and MAGIC trials, there are 2 standards of care for adjuvant therapy: postoperative chemoradiotherapy (CRT) and perioperative ECF chemotherapy. The important question arising from these studies is whether CRT is superior to chemotherapy alone as adjuvant therapy. This randomized phase II/III trial will compare CRT to chemotherapy alone in the preoperative setting. Methods: Patients with resectable adenocarcinoma of the stomach or gastroesophageal junction will be randomized to receive either preoperative chemotherapy alone (ECFx3 as per MAGIC regimen) or preoperative CRT (ECFx2 followed by 45Gy of radiation with concurrent 5-FU). Following surgery, both groups will receive 3 further cycles of ECF. The trial is being conducted in two Parts; Part I (phase II component) will recruit 120 patients with the aim of demonstrating sufficient efficacy and safety of preoperative CRT, as well as trial feasibility. Part II (phase III component) will recruit a further 632 patients to provide a total of 752. The primary endpoint for Part I is pathological complete response rate, and for Part 2 it is overall survival. The trial includes formal quality of life and biological sub-studies. In addition, the trial incorporates a rigorous quality assurance program that includes real time central review of radiotherapy plans and central review of surgical technique. Current status: This study is an international, intergroup trial led by the Australasian Gastro-Intestinal Trials Group (AGITG), in collaboration with the Trans-Tasman Radiation Oncology Group (TROG), European Organisation for Research and Treatment of Cancer (EORTC) and the NCIC Clinical Trials Group. To date, 36 patients have been recruited from 20 sites in Australia and New Zealand; European and Canadian sites will commence recruitment in 2012.

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