Gastric cancer – ASCO 2010

Abstract

Gastric cancer is still a devastating disease. Two thirds of the patients are diagnosed in a locally advanced or metastatic stage. Even if surgery is possible, long-term survival is low. Optimal therapy in a curative and a palliative setting is still not clear yet. ASCO 2010 could shed some light on optimal chemotherapy and the introduction of molecular targeted therapy. Th e aim of this article is to summarize the most important publications at this year's ASCO annual meeting and to put them into context of current therapeutic strategies.Patients with operable gastric cancer still have a poor prognosis and eff ective pre-or postoperative therapy is warranted. In a large Cochrane meta-analysis [1] 2128 patients from 13 randomized trials were analyzed. Patients received perioperative chemotherapy or radiotherapy for locally advanced adenocarcinoma of the stomach or the distal esophagus. With preoperative chemotherapy a signifi cant overall survival benefi t (hazard ratio (HR) 0.81; p< 0.0001) could be shown. Th is meta-analysis enforces the use of preoperative chemotherapy as standard of care for locally advanced gastric cancer and is well in line with recent phase III trials (MAGIC, ACCORD07; [2, 3]). Th e optimal neoadjuvant regimen, however, is still unclear [4]. In recent trials CF (cisplatin, 5FU) or ECF (epirubicin, cisplatin, 5FU) are investigated. Infusional 5FU however via continuous infusion is unpopular. In Abstract 4019 the fi rst safety data of the STO3 trial are presented [5]. In this large phase III trial inclusion of 1100 patients with operable gastric cancer is planned. Patients are randomized to receive ECX (epirubicin, cisplatin, and capecitabine) in the control arm and ECX plus bevacizumab in the experimental arm. Th ree cycles are administered preoperatively and three more after surgery. Th e fi rst 104 patients are analyzed and toxicity seems acceptable and comparable in both arms. Th e role of bevacizumab in the perioperative setting will be answered after the study is closed but the control arm may be a good choice for a feasible perioperative regimen since continuous infusional 5FU is replaced by oral capecitabine.Optimal preoperative staging in operable gastric cancer is still a matter of debate. If a staging laparoscopy is performed, it has been shown that a positive lavage is associated with a worse prognosis. An interesting study investigated this procedure in patients who received neoadjuvant chemotherapy [6]. As expected median survival was worse in patients with free peritoneal tumour cells in the lavage. 37% of these patients however presented with a negative lavage after neoadjuvant chemotherapy. Th ese patients showed the same favourable prognosis as patients with a negative fi rst peritoneal lavage. Patients who present with free peritoneal tumour cells should receive neoadjuvant chemotherapy. If their lavage turns negative, a median survival of 36 months and a twoyear survival rate of 71.4% could be reached (Tab. 1). Palliative chemotherapy First line therapyTh e optimal fi rst...

Oncology in 2010 – small steps towards personalized medicine with special focus on elderly cancer patients

“…Th us, adjuvant oxaliplatin-based chemotherapy could be considered in elderly patients, in stage II, however, FOLFOX 4 should only be recommended for high-risk elderly patients. In the metastatic setting, the role of cetuximab in KRAS-wild type patients has again been confi rmed.In this issue, new developments in gastric cancer have been summarized by E. Wöll [6]. A Cochrane meta-analysis proved that preoperative chemotherapy had a signifi cant overall survival benefi t, which supports the use of preoperative chemotherapy as a standard of care for locally advanced gastric cancer [7].…”

“…In this issue, new developments in gastric cancer have been summarized by E. Wöll [6]. A Cochrane meta-analysis proved that preoperative chemotherapy had a signifi cant overall survival benefi t, which supports the use of preoperative chemotherapy as a standard of care for locally advanced gastric cancer [7].…”