Neoadjuvant Chemotherapy for Gastric Cancer: What are we Trying to Accomplish?

Excerpt

Gastric cancer remains the second leading cause of cancer death in the world and is the most common cancer in Japan.1 Although surgery is the mainstay of curative treatment, even after complete resection, more than half of patients with locally advanced tumors recur, and fewer than 40 % survive beyond 3 years. Accordingly, investigators around the world have explored a variety of adjuvant and neoadjuvant multimodality treatment approaches to this disease. In North America, the standard approach has long been upfront surgery followed by adjuvant chemoradiotherapy based on the findings of the Intergroup 0116 trial, which showed that postoperative 5-fluorouracil (5-FU)/leucovorin-based chemoradiation increases overall survival compared with surgery alone.2 However, another standard of care for resectable gastric cancer in North America and Europe emerged with the publication of the MAGIC trial a few years later and the FNCLCC/FFCD multicenter phase III trial a few years after that. The MAGIC trial reported an improvement in overall survival with perioperative epirubicin, cisplatin, and 5-FU (ECF) compared with surgery alone, and the FNCLCC/FFCD trial showed an improved R0 resection rate and survival with perioperative 5-FU and cisplatin.3,4 …