Current adjuvant treatment modalities for gastric cancer: From history to the future

Abstract

The discrepancy between the surgical technique and the type of adjuvant chemotherapy used in clinical trials and patient outcomes in terms of overall survival rates has led to the generation of different adjuvant treatment protocols in distinct parts of the world. The adjuvant treatment recommendation is generally chemoradiotherapy in the United States, perioperative chemotherapy in the United Kingdom and parts of Europe, and chemotherapy in Asia. These options mainly rely on the United States Intergroup-0116, United Kingdom British Medical Research Council Adjuvant Gastric Infusional Chemotherapy, and the Asian Adjuvant Chemotherapy Trial of S-1 for Gastric Cancer and Capecitabine and Oxaliplatin Adjuvant Study in Stomach Cancer trials. However, the benefits were evident for only certain patients, which were not very homogeneous regarding the type of surgery, chemotherapy regimens, and stage of disease. Whether the dissimilarities in survival are attributable to surgical technique or intrinsic biological differences is a subject of debate. Regardless of the extent of surgery, multimodal therapy may offer modest survival advantage at least for diseases with lymph node involvement. Moreover, in the era of individualized treatment for most of the other cancer types, identification of special subgroups comprising those who will derive more or no benefit from adjuvant therapy merits further investigation. The aim of this review is to reveal the historical evolution and future reflections of adjuvant treatment modalities for resected gastric cancer patients. Core tip: Despite extensive surgery, gastric cancer will likely recur for most patients. Fortunately, additional treatment modalities either in the perioperative or postoperative setting provide varying degrees of survival

Stomach cancer survival in the United States by race and stage (2001‐2009): Findings from the CONCORD‐2 study

“…Although stomach cancer has a poor prognosis, the increases in overall survival for all stages between the 2 periods are positive, especially because there was an increase in the proportion of the types with the worst prognosis—cardia and diffuse—in the total pool of stomach cancers. The improvement in survival for each stage could be because of better therapy regimens or more access to appropriate treatment …”

“…Diagnosis is by endoscopy and biopsy; computed tomography scans of the chest, abdomen, and pelvis are required to determine stage at diagnosis . Adjuvant chemotherapy and chemoradiotherapy after resection of stomach cancer offer survival benefits, but the discrepancies between the surgical technique and type of adjuvant chemotherapy used in clinical trials and survival probabilities have resulted in different adjuvant treatment protocols . The major challenge for clinicians is treatment sequence .…”

“…Adjuvant chemotherapy and chemoradiotherapy after resection of stomach cancer offer survival benefits, but the discrepancies between the surgical technique and type of adjuvant chemotherapy used in clinical trials and survival probabilities have resulted in different adjuvant treatment protocols . The major challenge for clinicians is treatment sequence . New studies are needed to determine the best therapy.…”

Comparison of perioperative chemotherapy with adjuvant chemoradiotherapy for resectable gastric cancer: findings from a population-based study

“…In contrast, the majority of patients (54%) in the INT0166 trial underwent a D0 lymphadenectomy (7). Additionally, improvement in radiation therapy delivery modalities (19) and changes in chemotherapy regimens (20) during recent years might have contributed to improved outcomes observed for CRT. It has also been argued that the benefits of CRT observed in INT0166 trial resulted from adjuvant therapy merely compensating for inadequate surgery (21).…”

The Prognostic Significance of Compliance with Postoperative Adjuvant Chemotherapy in Patients with Stage III Gastric Cancer: an Observational Study

“…Curative resection is the treatment of choice for patients with gastric cancer; however, according to several recent large-scale studies, only 30%–50% of patients with gastric cancer remain disease-free after undergoing radical resections [ 2 3 ]. A large proportion of patients are diagnosed with loco-regionally advanced disease, which results in high loco-regional and distant recurrence rates, with poor survival [ 4 5 ]. For patients with potentially curable gastric cancer, randomized trials have indicated that a number of approaches, including postoperative adjuvant chemotherapy, can provide significant survival benefits over surgery alone [ 6 7 ].…”