Recent updates in perioperative chemotherapy and recurrence pattern of gastric cancer

Abstract

Gastrectomy with D2 lymph node dissection has become the global standard procedure for locally advanced gastric cancer to maximally reduce locoregional recurrence. In East Asia, based on the evidence of the ACTS‐GC and the CLASSIC trials, postadjuvant chemotherapy with S‐1 monotherapy or capecitabine and oxaliplatin after curative D2 gastrectomy is the current standard strategy. However, approximately 20% to 30% of patients still develop distant recurrence even after these postadjuvant chemotherapies, especially in those with pathological stage III disease. This review summarizes recent (2008‐2018) evidence on the benefits of adjuvant therapy for locally advanced gastric cancer. JACRO GC‐07, a Phase III trial, recently showed a superior 3‐year recurrence‐free survival of the S‐1 plus docetaxel regimen in comparison to S‐1 monotherapy for patients with pathological stage III gastric cancer after curative D2 gastrectomy. With regard to recent new evidence on neoadjuvant strategy, JCOG0501, a Phase III trial, did not show any superiority in 3‐year overall survival (OS) of additional neoadjuvant chemotherapy with S‐1/cisplatin over postadjuvant S‐1 monotherapy in scirrhous type gastric cancer. Further clinical trials of neoadjuvant chemotherapy are ongoing to improve the poor prognosis for gastric cancer with extensive lymph node metastases. These trials could lead to new evidence for improved treatment of gastric cancer in the near future.

Evaluation of Systemic Inflammatory Response and Nutritional Biomarkers as Predictive Factors in Patients with Recurrent Gastric Cancer

“…Based on the results of the previous pivotal randomized phase III trials, adjuvant chemotherapy is usually performed after surgery, in order to circulate the anticancer drug(s) throughout the entire body via the bloodstream to control micrometastases and prevent recurrence [4,25,26]. Although postoperative adjuvant chemotherapy is effective in the survival of patients with locally advanced gastric cancer, approximately 20-30% of patients still develop recurrence [19][20][21][22][23][24][25][26][27][28]. The results of the Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer (ACTS-GC) showed the median time from recurrence to death for recurrent gastric cancer patients was 11.4 months [26,28].…”

Combination of apatinib mesylate and second-line chemotherapy for treating gastroesophageal junction adenocarcinoma

“…8 A number of studies have shown that postoperative adjuvant therapy is an important factor in reducing local recurrence rate and improving survival. 9–11…”

Optimization of perioperative approaches for advanced and late stages of gastric cancer: clinical proposal based on literature evidence, personal experience, and ongoing trials and research

“…FOCUS (IdentifierNCT01364376) is an ongoing trial comparing the efficiency of SOX versus FOLFOX in a neoadjuvant setting. RESOLVE 2 (Identifier NCT03691454) and MATCH (Identifier NCT02725424) are ongoing trial investigating the efficacy of SOX versus DOS with/without trastuzumab in a neoadjuvant setting [26].…”