Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer

Mieno, Hiroaki; Yamashita, Keishi; Hosoda, Kei; Moriya, Hiromitsu; Higuchi, Katsuhiko; Azuma, Mizutomo; Komori, Shouko; Yoshida, Tsutomu; Tanabe, Satoshi; Koizumi, Wasaburo; Katada, Natsuya; Watanabe, Masahiko

doi:10.1007/s00595-017-1512-z

Cited by 27 publications

(22 citation statements)

References 39 publications

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“…In this study, we have implemented a propensity score modeling, producing a matched cohort based on baseline characteristics, as well as the extent of initial biological disease, before palliative chemotherapy and response to chemotherapy. Our findings were consistent with previous studies that advocated conversion surgery if R0 resection could be achieved, even after adjusting for potential confounding factors [9,10,12,21,22]. It is noteworthy that patients who underwent conversion surgery exhibited a longer survival rate after additionally excluding early disease progression in the chemotherapy only group.…”

Section: Discussionsupporting

confidence: 91%

“…The prognosis for those undergoing systemic therapies only for gastric cancers who were either initially diagnosed as metastatic or having developed recurrence after initial curative resection was dismal, in spite of recent advancements made in targeted and immune-based therapies [3]. Accordingly, there have been attempts to proceed to conversion surgery in metastatic gastric cancer in an effort to add survival benefit to chemotherapy even when systemic treatment only could at least temporarily control the microscopic disease [4][5][6][7][8][9][10][11][12].…”

Section: Discussionmentioning

confidence: 99%

“…This is because surgery is currently the only option for curative treatment in advanced gastric cancer. Consequently, previous reports that studied conversion surgery in metastatic gastric cancer have adopted observational study models [4,[6][7][8]10,[15][16][17][18][19][20]. For this reason, most previous studies have obvious inherent limitations associated with selection bias in patients who received conversion surgery, i.e., better initial response to systemic chemotherapy or a lesser degree of peritoneal seeding, compared with the group who only received palliative chemotherapy.…”

Section: Discussionmentioning

confidence: 99%

“…Conversion surgery is a term for operative resection of primary or metastatic lesions with a curative intent, after confirming either a complete response (CR) or partial response (PR), following several cycles of palliative chemotherapy. Although addition of gastrectomy (without metastasectomy) to palliative chemotherapy in metastatic gastric cancer did not show survival benefit when compared with chemotherapy only in the previous REGATTA trial [4], there have been recent attempts to conduct surgery in selected patients with a good initial response to palliative chemotherapy [5][6][7][8][9][10][11][12]. It has been shown to improve the prognosis in a few retrospective studies.…”

Section: Introductionmentioning

confidence: 99%

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Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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The role of conversion surgery in metastatic gastric cancer remains unclear. Cancer dormancy markers might have a role in predicting the survival in patients with conversion surgery. We identified 26 patients who went through conversion surgery, i.e., a curative-intent gastrectomy with metastasectomy after chemotherapy in initially metastatic gastric cancer. As controls, 114 potential candidates for conversion surgery who only received chemotherapy were included for the propensity score matching. Conversion surgery showed a significantly longer overall survival (OS) compared with only palliative chemotherapy (median-43.6 vs. 14.0 months, respectively, p < 0.001). This better survival in the conversion surgery group persisted even after propensity matching (p < 0.001), and also when compared to patients with tumor response over 5.1 months in the chemotherapy only group (p = 0.005). In the conversion surgery group, OS was longer in patients with R0 resection (22/26, 84.6%) than without R0 resection (4/26, 15.4%) (median-not reached vs 22.1 months, respectively, p = 0.005). Although it should be interpreted with caution due to the primitive analysis in a small population, the positive expression of NR2F1 showed a longer duration of disease-free survival (DFS) after conversion surgery (p = 0.016). In conclusion, conversion surgery showed a durable OS even in patients with initially metastatic gastric cancer when R0 resection was achieved after chemotherapy.

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Choe

Kim

Han

et al. 2019

Cancers

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“…Meanwhile, para-aortic lymph nodes were not classified as regional lymph nodes in the Japanese classification of gastric carcinoma [8]. We considered that para-aortic metastasis is a distant metastasis and developed an original treatment strategy for this type of cancer [14]. This is why we excluded patients with para-aortic lymph node metastasis from the present study.…”

Section: Discussionmentioning

confidence: 99%

A phase II study of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1, followed by gastrectomy with D2 lymph node dissection for high-risk advanced gastric cancer: results of the KDOG1001 trial

et al. 2018

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Background The prognosis of patients with gastric cancer with bulky node metastasis, linitis plastica (type 4), or large ulceroinvasive-type tumors (type 3) remains poor. We conducted a phase II study to evaluate the safety and efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1 (DCS) for establishing a new treatment modality that improves prognosis. Methods Patients received up to four 28-day cycles of DCS therapy (docetaxel at 40 mg/m 2 , cisplatin at 60 mg/m 2 on day 1, and S-1 at 40 mg/m 2 twice daily for 2 weeks) followed by gastrectomy with D2 nodal dissection. S-1 chemotherapy was administered for 1 year after surgical resection. The primary endpoint was the percentage of complete resections of the primary tumor with clear margins (R0 resection). The planned sample size was 40; this was calculated based on an expected R0 rate of 85% and a threshold R0 rate of 65%, with a one-sided alpha of 5% and a power of 90%. Results Between 2010 and 2017, 40 patients were enrolled. The R0 resection rate was 90%. The most common grade 3 or 4 adverse events during DCS therapy were leukocytopenia (27.5%), neutropenia (55.0%), and hyponatremia (22.5%). The most common grade 3 or 4 surgical morbidity was pancreatic fistula (12.5%); mortality was 0%. The pathological response rate was 57.5% with a grade 3 histological response rate of 8%. Conclusions Neoadjuvant chemotherapy with DCS was feasible and showed a sufficient R0 resection rate. A future study with a sufficient follow-up period should confirm survival outcomes.

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Re‐emerging role of macroscopic appearance in treatment strategy for gastric cancer

Hosoda

Watanabe

Yamashita

2018

Annals of Gastroent Surgery

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Pathological outcomes are definitely the most important prognostic factors in gastric cancer, but they can be obtained only after surgical resection. Use of preoperative adjuvant chemotherapy is becoming widespread for aggressive human cancer, so clinical factors such as macroscopic features are important as they are highly predictive for patient prognosis. In gastric cancer, the macroscopic type represents a distinct prognosis; Type 0 represents early gastric cancer with excellent prognosis, but, among advanced tumors, giant Type III and Type IV tumors have a dismal prognosis. Japan Clinical Oncology Group (JCOG) Stomach Cancer Study Group adopted macroscopic features as high‐risk entities in clinical trials. It makes sense for risk classification to use macroscopic phenotypes because The Cancer Genome Atlas (TCGA) Network has lately subcategorized different histologies associated with specific macroscopic types by the molecular features of the whole genome. Dismal prognosis of Type IV gastric cancer is notorious, but similar prognosis was seen in giant Type III gastric cancer defined as 8 cm or beyond, both of which are unique for their propensity of peritoneal dissemination. In this review, clinical relevance including prognosis of such macroscopic high‐risk features will be separately debated in the context of precision medicine and updated prognostic outcomes will be presented under the present standard therapy of curative surgery followed by postoperative S‐1 chemotherapy. Moreover, promising emerging novel therapeutic strategies including trimodal potent regimens or intraperitoneal chemotherapy will be described for such aggressive gastric cancer.

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Conversion surgery after combination chemotherapy of docetaxel, cisplatin and S-1 (DCS) for far-advanced gastric cancer

Abstract: Surgical resection after DCS chemotherapy for initially unresectable gastric cancer was safe and provided a reasonable R0 resection rate and good mid-term survival.

Cited by 27 publications

References 39 publications

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

Conversion Surgery in Metastatic Gastric Cancer and Cancer Dormancy as a Prognostic Biomarker

A phase II study of neoadjuvant chemotherapy with docetaxel, cisplatin, and S-1, followed by gastrectomy with D2 lymph node dissection for high-risk advanced gastric cancer: results of the KDOG1001 trial

Re‐emerging role of macroscopic appearance in treatment strategy for gastric cancer

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