Benefit of Adjuvant Chemotherapy for Resectable Gastric Cancer

gastric,; Paolettí, Xavier; Oba, Koji; Burzykowski, Tomasz; Michiels, Stefan; Ohashi, Yasuo; Pignon, Jean-Pierre; Rougier, Philippe; Sakamoto, Junichi; Sargent, Daniel J.; Sasako, Mitsuru; Cutsem, Éric Van; Buyse, Marc

doi:10.1001/jama.2010.534

Cited by 690 publications

(234 citation statements)

References 51 publications

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“…Adjuvant chemotherapy is currently regarded as the standard protocol for patients with stage II or III gastric cancer based on National Comprehensive Cancer Network guidelines23, 24. However, the criteria for selection of candidates who are likely to benefit from adjuvant chemotherapy remain controversial2, 24.…”

Section: Discussionmentioning

confidence: 99%

Gene expression profiles for a prognostic immunoscore in gastric cancer

Zeng

Zhou

et al. 2018

British Journal of Surgery

193

185

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BackgroundIncreasing evidence has indicated an association between immune infiltration in gastric cancer and clinical outcome. However, reliable prognostic signatures, based on systematic assessments of the immune landscape inferred from bulk tumour transcriptomes, have not been established. The aim was to develop an immune signature, based on the cellular composition of the immune infiltrate inferred from bulk tumour transcriptomes, to improve the prognostic predictions of gastric cancer.MethodsTwenty‐two types of immune cell fraction were estimated based on large public gastric cancer cohorts from the Gene Expression Omnibus using CIBERSORT. An immunoscore based on the fraction of immune cell types was then constructed using a least absolute shrinkage and selection operator (LASSO) Cox regression model.ResultsUsing the LASSO model, an immunoscore was established consisting of 11 types of immune cell fraction. In the training cohort (490 patients), significant differences were found between high‐ and low‐immunoscore groups in overall survival across and within subpopulations with an identical TNM stage. Multivariable analysis revealed that the immunoscore was an independent prognostic factor (hazard ratio 1·92, 95 per cent c.i. 1·54 to 2·40). The prognostic value of the immunoscore was also confirmed in the validation (210) and entire (700) cohorts.ConclusionThe proposed immunoscore represents a promising signature for estimating overall survival in patients with gastric cancer.

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Section: Discussionmentioning

confidence: 99%

Gene expression profiles for a prognostic immunoscore in gastric cancer

Zeng

Zhou

et al. 2018

British Journal of Surgery

193

185

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“…More recently, the CLASSIC study reported a higher 5year OS in patients with stage II or III gastric cancer who received adjuvant chemotherapy treatment with capecitabine plus oxaliplatin compared to patients who underwent only D2 gastrectomy (5year OS rate: 78% vs 69%; HR = 0.58, 95%CI: 0.470.72, P < 0.0001) [15] . Finally, a metaanalysis by the Global Advanced/ Adjuvant Stomach Tumor RESEARCH International Collaboration (GASTRIC) Group that combined data from 3838 patients (17 trials) showed a benefit of 5-FUbased adjuvant chemotherapy vs surgery alone on OS (55.3% vs 49.6%, respectively; HR = 0.82, 95%CI: 0.760.90, P < 0.001) with stable results at 10 years (48% vs 40%, respectively) [16] . For this reason, 5FU based adjuvant chemotherapy is now considered as a therapeutic option and has been included in the French National Thesaurus of Digestive Oncology (www.snfge.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

“…Recently, a metaanalysis showed that addition of an anthracycline to the CDDP and 5FU regimens increased the OS of patients with advanced disease, but this Samalin E et al . Neoadjuvant therapy for gastroesophageal adenocarcinoma advantage was not reported in the GASTRIC meta analysis that combined data from 3226 patients [16,28] . A recently published French trial (FNCLCC 94012 FFCD 9703) evaluated another perioperative (two neoadjuvant cycles and four postoperative cycles) chemotherapy regimen (continuous protracted intra venous infusion of 5FU 800 mg/m² per day from days 1 to 4 and 100 mg/m² CDDP on day 1 or 2 every 4 wk) [29] .…”

Section: Neoadjuvant Chemotherapymentioning

confidence: 99%

Neoadjuvant therapy for gastroesophageal adenocarcinoma

Samalin

Ychou

2016

WJCO

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Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. While the incidence of gastric adenocarcinoma is decreasing, the incidence of gastroesophageal junction adenocarcinoma is rising rapidly in Western countries. Considering that surgical resection is currently the major curative treatment, and that the 5-year survival rate highly depends on the pTNM stage at diagnosis, gastroesophageal adenocarcinoma management is very challenging for oncologists. Several treatment strategies are being evaluated, and among them systemic chemotherapy, to decrease recurrences and improve overall survival. The MAGIC and FNCLCC-FFCD trials showed a survival benefit of perioperative chemotherapy in patients with operable gastric and lower esophageal cancer, and these results had an impact on the European clinical practice. New strategies, including induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies in combination with perioperative chemotherapy and the new cytotoxic regimens, are currently assessed to improve current standards and help developing patienttailored therapeutic interventions. Core tip: Gastric and esophageal adenocarcinomas are one of the main causes of cancer-related death worldwide. The incidence of gastroesophageal junction adenocarcinoma is rapidly rising in Western countries. Surgical resection is currently the major curative treatment. As the 5-year survival rate highly depends on the pTNM stage, the treatment strategy is very challenging for oncologists. Several treatments, including systemic chemotherapy, are being assessed to prevent recurrences and improve overall survival. New strategies, such as induction chemotherapy followed by preoperative chemoradiotherapy, targeted therapies and new cytotoxic regimens in perioperative chemotherapy, are currently assessed to improve current standards and develop more tailored therapeutic interventions.

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“…It seems that this regimen might be an alternative to the S-1 regimen. A meta-analysis on 17 trials of adjuvant chemotherapy after gastrectomy showed a small but significant benefit for 5-FU-based chemotherapy [66] . Adjuvant chemotherapy increased OS by 6%, and reduced the risk of death by 18%.…”

Section: Adjuvant Chemotherapymentioning

confidence: 99%

Multimodal treatment of gastric cancer in the west: Where are we going?

Marrelli

Połom

Manzoni

et al. 2015

WJG

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The incidence of gastric cancer (GC) is decreasing worldwide, especially for intestinal histotype of the distal third of the stomach. On the contrary, proximal location and diffuse Lauren histotype have been reported to be generally stable over time. In the west, no clear improvement in long-term results was observed in clinical and population-based studies. Results of treatment in these neoplasms are strictly dependent on tumor stage. Adequate surgery and extended lymphadenectomy are associated with good long-term outcome in early-stage cancer; however, results are still unsatisfactory for advanced stages (Ⅲ and Ⅳ), for which additional treatments could provide a survival benefit. This implies a tailored approach to GC. The aim of this review was to summarize the main multimodal treatment options in advanced resectable GC. Perioperative or postoperative treatments, including chemotherapy, chemoradiotherapy, targeted therapies, and hyperthermic intraperitoneal chemotherapy have been reviewed, and the main ongoing and completed trials have been analyzed. An original tailored multimodal approach to non-cardia GC has been also proposed.

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Benefit of Adjuvant Chemotherapy for Resectable Gastric Cancer

Abstract: Among the RCTs included, postoperative adjuvant chemotherapy based on fluorouracil regimens was associated with reduced risk of death in gastric cancer compared with surgery alone.

Cited by 690 publications

References 51 publications

Gene expression profiles for a prognostic immunoscore in gastric cancer

Gene expression profiles for a prognostic immunoscore in gastric cancer

Neoadjuvant therapy for gastroesophageal adenocarcinoma

Multimodal treatment of gastric cancer in the west: Where are we going?

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