Perioperative therapy in gastric cancer

Wöll, Ewald

doi:10.1007/s12254-008-0021-6

Cited by 5 publications

(3 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Periand postoperative complications, however, were not much diff erent. In summary, although not signifi cant for the primary endpoint this trial stands in line with the three other neoadjuvant trials and supports the use of preoperative chemotherapy in operable gastric adenocarcinoma or adenocarcinoma of the gastro oesophageal junction [4].…”

Section: Adjuvant Perioperative and Neoadjuvant Therapysupporting

confidence: 77%

Gastric cancer – ASCO 2009

Wöll¹

2009

memo

View full text Add to dashboard Cite

Individualized tumour therapy was the leading theme of this year's ASCO. In this context Her2Neu testing could detect a subgroup of patients suff ering from advanced gastric cancer who showed substantial benefi t from the addition of trastuzumab to standard chemotherapy. Th is fi rst phase III trial with a biological agent is the beginning of individualized tumour therapy in gastric cancer. Th ese data will be discussed together with other abstracts from ASCO 2009 and set into context with current therapeutic strategies. Adjuvant, perioperative and neoadjuvant therapyTwo recent trials favour pre-and perioperative chemotheray in operable gastric adenocarcinoma [1,2]. A third Swiss randomized trial was closed early due to slow recruitment.Although not conclusive as far as the primary endpoint is concerned, this trial confi rms the problems of postoperative chemotherapy in gastric cancer. At this year's ASCO meeting the 4th randomized trial investigating neoadjuvant chemotherapy followed by D2 resection versus surgery alone was presented [3]. Unfortunately this trial has also been stopped early due to low accrual. Of the planned 360 patients only 144 have been randomized to receive two cycles of preoperative chemotherapy with 5FU, leucovorin and cisplatin followed by surgery or surgery alone. Due to the low power and the excellent median survival of over 36 months in both arms the overall survival (HR 0.84, p = 0.466) and the time to progression (HR 0.66; p = 0.065) were not signifi cantly diff erent. Th e rate of R0 resection, however, diff ered with 81.9% in the experimental arm and 66.7% in the control arm (p = 0.036). Toxicity was higher in the chemotherapy arm as would be expected. Periand postoperative complications, however, were not much diff erent. In summary, although not signifi cant for the primary endpoint this trial stands in line with the three other neoadjuvant trials and supports the use of preoperative chemotherapy in operable gastric adenocarcinoma or adenocarcinoma of the gastro oesophageal junction [4].A second option is postoperative adjuvant radiochemotherapy as shown by the intergroup trial 0116 [5]. Macdonald reported this year the updated data [6]. With a median followup time of over 10 years the overall survival (HR 1.32, p = 0.004) and the DFS (HR 1.51, p < 0.001) are still favouring postoperative radiochemotherapy over surgery alone. Th e subgroup analysis showed an eff ect in every subgroup except cases of diff use histology. Th e toxicity of this approach is high and postoperative therapy is diffi cult to apply in most patients after gastric surgery. Th erefore this approach is not a generally accepted standard. Palliative therapyEric van Cutsem presented the data of the ToGA trial [7]. In this large phase III trial 3807 chemo naïve patients with inoperable gastric cancer were screened for Her2Neu overexpression. A total of 22.1% were Her2 positive as by immunohistochemistry (3+) or FISH. Of these patients 595 were randomized to receive Chemotherapy with 5FU or Capecitabine plus Cispla...

show abstract

Section: Adjuvant Perioperative and Neoadjuvant Therapysupporting

confidence: 77%

Gastric cancer – ASCO 2009

Wöll¹

2009

memo

View full text Add to dashboard Cite

show abstract

“…However, because of delayed recovery from surgery (especially in lung, colorectal and gastric cancer) many patients are not fi t enough to receive chemotherapy postoperatively. Consequently, neoadjuvant strategies could help to overcome these limitations, as it can be off ered to the majority of patients and is tolerated better than postoperative therapy [3]. Another theoretical advantage is that R0 resection rates might be higher and the chemo-sensitivity of the tumour can be tested in vivo.…”

Section: -Neoadjuvant Strategies Are Sometimes Advantageousmentioning

confidence: 99%

Are adjuvant therapies beyond all doubt?

Hilbe¹,

Gunsilius²

2008

memo

View full text Add to dashboard Cite

“…Th ese results are in accordance with earlier meta-analysis. Th e small benefi t, the mixed patient collectives and the diffi culty to administer postoperative chemotherapy in gastric cancer patients, however, do not favour the routine use of adjuvant chemotherapy in Caucasian patients (for review see 14) Th e eff ect of intraperitoneal chemotherapy with cisplatin is investigated in a large phase III trial [15]. Th e authors randomized 521 serosa-positive patients to receive postoperative chemotherapy with or without intraperitoneal cisplatin administration.…”

Section: Adjuvant Neoadjuvant Chemotherapymentioning

confidence: 99%

Gastric cancer

Wöll¹

2008

memo

Self Cite

View full text Add to dashboard Cite

Overall survival of patients suff ering from gastric cancer is still poor. Two-thirds of patients are diagnosed in a locally advanced stage or with metastatic tumour. But even in patients with operable disease recurrence rate is high. To increase the prognosis of this devastating disease much eff ort has been put in the development of curative and palliative therapy concepts recently. Th e aim of this article is to summarize the most important publications at this year's ASCO meeting and to put them into context of current therapeutic strategies. Palliative chemotherapyAn Asian phase III trial investigated the eff ect of the oral 5FU prodrug S1 in combination with 5FU compared to S1 and cisplatin or S1 monotherapy [1]. Th e combination S1 and cisplatin was superior to 5FU/S1 or S1 monotherapy as far as response rate and overall survival are concerned. Th e authors conclude that this will be the new Chinese standard. Given the substantial diff erences of S1 pharmacokinetics and because of the high interethnic variability [2] it remains to be shown whether this substance proves its effi cacy in a Caucasian population. Th e large international FLAGS trial investigating this issue in a western population will help to answer this question.A second phase III trial in inoperable gastric cancer patients compared docetaxel/cisplatin versus 5FU/cisplatin [3]. Both combinations showed comparable response rates and comparable overall survival of 9.4 and 10.2 months, respectively. Th e only diff erence could be shown in toxicity. Docetaxel/cisplatin showed more haematotoxicity whereas 5FU/cisplatin showed more gastrointestinal side eff ects.An interim analysis of a large (n = 3106, 17 randomized trials) individual patient data-based meta-analysis elucidated the benefi t of FU derivatives, anthracyclines, platinum salts, taxanes or irinotecan in the palliative setting [4]. Only the taxane-based regimens showed an overall survival benefi t compared with all other combinations but this result is mainly based on two trials. Th erefore fi nal analysis of this meta-analysis has to be awaited until conclusions can be drawn.Many phase II trials investigated diff erent chemotherapy doublets or triplets (Tab. 1). Th ese data support the role of taxanes, capecitabin, oxaliplatin as well as 5FU and cisplatin as active substances in the treatment of gastric cancer. Two phase II trials investigated sequential therapy strategies showing comparable effi cacy but lower toxicity (Tab. 2) making this approach interesting for the generation of future trials.Even in second and third line therapies phase II trials showed effi cacy (Tab. 3). In this partially heavily pre-treated cohort remission rates between 18% and 34% could be achieved with overall survival from 5 to 15 months. Although phase III trials in this setting are most likely unrealistic these phase II data among earlier trials favour second or even third line chemotherapy in selected patients. BiologicalsOnly phase II data are available as far as targeted therapies are concerned. Cetux...

show abstract

Perioperative therapy in gastric cancer

Cited by 5 publications

References 16 publications

Gastric cancer – ASCO 2009

Gastric cancer – ASCO 2009

Are adjuvant therapies beyond all doubt?

Gastric cancer

Contact Info

Product

Resources

About