2201 Peri-operative chemotherapy ± bevacizumab for resectable gastro-oesophageal adenocarcinoma: Results from the UK Medical Research Council randomised ST03 trial (ISRCTN 46020948)

Cunningham, David A.; Smyth, E.; Stenning, Sally; Stevenson, Leanne; Robb, Claire; Allum, W. H.; Grabsch, Heike; Alderson, Derek; Riddell, Anna; Chua, Sue; Crosby, Tom; Mason, RC; Griffin, Michael; Mansoor, Was; Coxon, Fareeda Y.; Falk, S.; Rowley, S.; Sumpter, Katherine; Blazeby, J M; Langley, R.

doi:10.1016/s0959-8049(16)31118-2

Cited by 30 publications

(19 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In the substantive part of this ST03 trial, patients with esophageal and junctional adenocarcinoma of stomach or junction were randomised to ECX chemotherapy or ECX in combination with the VEGF inhibitor bevacizumab, for 3 cycles before and after surgery, with a further 6 maintenance doses in the bevacizumab arm. Although no differences in survival were reported, a high anastomotic leak rate (23%) in patients undergoing esophageal surgery on the experimental arm, compared with 9% in the ECX arm, with 30 day mortalities of 11% and 5%, respectively, resulting in closure of recruitment to patients with esophageal and junctional tumors in 2013 (33) With respect to immunotherapy, an industry sponsored phase III trial will randomise patients who have undergone neoadjuvant chemoradiotherapy and surgery to adjuvant nivolumab or placebo (Checkmate 577, NCT02743494) (34). Nivolumab is a human IGG4 anti-PD-1 monoclonal antibody which acts as a checkpoint inhibitor which prevents inactivation of anti-tumour T cells (35).…”

Section: Question 2: Trials Of Targeted Therapies and Immune Based Apmentioning

confidence: 94%

Neoadjuvant treatment of locally advanced esophageal and junctional cancer: the evidence-base, current key questions and clinical trials

Donohoe¹,

Reynolds²

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

Recent trials, including CROSS, MAGIC, ACCORD, and OEO2, have established neoadjuvant therapy as standard of care for locally advanced (cT 2-3 N any M 0 ) esophageal and junctional cancer compared with surgery alone. The CROSS trial in particular defines a new benchmark for outcomes from multimodal therapy, with a 5 year survival rate of 47% , a median survival of 47 months, a pathologic complete response rate (pCR) of 29% and an R0 resection rate of 92%. Several key questions remain, in particular whether CROSS-regimen chemoradiotherapy is superior to neoadjuvant chemotherapy alone for esophageal cancer, in particular adenocarcinoma. Second, with respect to neoadjuvant chemoradiation, whether an apparent complete clinical response can justify a "watch and wait" surveillance policy, with salvage surgery reserved for where relapse occurs. Third, whether with modern staging, predicted node negative cT2 tumors merit neoadjuvant therapy as standard. Finally, with the enormous interest in the application of targeted and immune-based therapies, and positive leads from other cancers, whether such approaches can improve outcomes in patients undergoing treatment with curative intent. We review herein a brief overview of the existing evidence-base and current active trials addressing these key questions.

show abstract

Section: Question 2: Trials Of Targeted Therapies and Immune Based Apmentioning

confidence: 94%

Neoadjuvant treatment of locally advanced esophageal and junctional cancer: the evidence-base, current key questions and clinical trials

Donohoe¹,

Reynolds²

2017

J. Thorac. Dis.

View full text Add to dashboard Cite

show abstract

“…The addition of the anti-VEGF antibody bevacizumab to perioperative ECX revealed to be feasible but failed to improve survival in the United Kingdom STO-3 study [35,36]. This negative study result highlights the need to better understand the role and function of treatment targets in the adjuvant treatment of gastric cancer.…”

Section: Accepted Manuscriptmentioning

confidence: 99%

Gastric cancer adjuvant therapy

Lordick

Terashima

2016

Best Practice & Research Clinical Gastroenterology

View full text Add to dashboard Cite

“…A follow up British trial that added bevacizumab to preoperative chemotherapy failed to demonstrate any benefit in OS and complication rates were substantial. 28–30 Currently, we recommend to consider perioperative chemotherapy in patients who have clinical ≥T2 any N primary. Similarly, all GAC patients considered appropriate for perioperative therapy, should also be considered for a staging laparoscopy before initiation of therapy.…”

Section: Gastric Adenocarcinomamentioning

confidence: 99%

Potentially Curable Cancers of the Esophagus and Stomach

Elimova

Kaya

Harada

et al. 2016

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Gastric and gastroesophageal adenocarcinomas continue to be a significant health burden globally and collectively represent the third leading cause of cancer death. When metastatic, most patients succumb to their cancer because of a limited number of modestly effective regimens available today. The progress against these cancers has been slow compared to many other solid tumors despite many attempts. In depth molecular profiling is also not completed. Even when these cancers are localized, they impose significant challenges for the patient, relatives, and treating team alike. Localized gastric or gastroesophageal cancer is best managed by a multidisciplinary approach. This review will focus on the management of localized cancers by reviewing the current literature and explaining certain principles that help guide therapy of these patients. The future, however, will afford a number of opportunities including exploitation of the Cancer Genome Atlas (TCGA) generated initial data to identify novel targets and drugs, harnessing the prowess of the immune system, and finally, customizing therapy for each patient. Localized gastric or gastroesophageal cancer is best managed by a multidisciplinary approach and involves multimodality therapy of locally advanced disease and team work. The exploitation of the Cancer Genome Atlas (TCGA) generated initial data to identify novel targets and drugs, harnessing the prowess of the immune system, and finally, customizing therapy for each patient.

show abstract

2201 Peri-operative chemotherapy ± bevacizumab for resectable gastro-oesophageal adenocarcinoma: Results from the UK Medical Research Council randomised ST03 trial (ISRCTN 46020948)

Cited by 30 publications

References 0 publications

Neoadjuvant treatment of locally advanced esophageal and junctional cancer: the evidence-base, current key questions and clinical trials

Neoadjuvant treatment of locally advanced esophageal and junctional cancer: the evidence-base, current key questions and clinical trials

Gastric cancer adjuvant therapy

Potentially Curable Cancers of the Esophagus and Stomach

Contact Info

Product

Resources

About