MAGIC in practice: Experience of peri‐operative ECF/X chemotherapy in gastro‐esophageal adenocarcinomas

Abstract

Our patient population is older than the patients in the MAGIC trial (age 66 years vs. 62 years) with a much higher proportion of esophageal and GEJ tumours. Overall, curative resection rate was comparable to the MAGIC trial. Overall survival is superior to that found in the MAGIC trial.

Outcomes among patients treated for gastric adenocarcinoma during the last decade

“…In both studies toxicity associated with chemotherapy was high, and less than 50% of the patients were able to complete the scheduled treatment cycles. This is in accordance with two recent studies 15, 16 reporting the experience with the ECX/EOX regimen in a clinical setting. This raises questions as to the potential effect of preoperative (neoadjuvant) chemotherapy regimens alone, as severe toxicity and non‐compliance primarily was associated with the post‐surgery chemotherapy part.…”

The role of adjuvant platinum‐based chemotherapy in esophagogastric cancer patients who received neoadjuvant chemotherapy prior to definitive surgery

“…The mid‐point Mandard TRG of 3 is defined as “fibrosis predominates” with chemotherapy appearing to provide some benefit, and so while TRG 3 may not have such a robust degree of response as TRG 1‐2, it cannot be grouped with TRG 4‐5 patients, who do not appear to have any tangible response to chemotherapy. Therefore, although Mandard 3 tumors do not display a significant degree of response, they have been loosely grouped with TRG 1‐2 tumors representing chemo‐sensitivity, as elsewhere in the literature …”

“…Patients administered ECX chemotherapy and undergoing surgery were included in the study on an intention to treat basis, however not all patients received the designated six cycles at full dose. Toxicity related complications are well documented with the ECX regimen so treatment regimens were modified if necessary to meet individual patient requirements. Therefore, a number of patients in our study group underwent dose reductions, cycle delays, and occasionally reduced cycle numbers.…”

“…Despite the overall survival advantage conferred to all patients by undergoing perioperative MAGIC chemotherapy with resectional surgery, only 30‐40% of patients within the cohort will demonstrate a response to the chemotherapy regimen. This improved survival is demonstrated in spite of patients in this cohort not receiving the full MAGIC regimen due to common issues such as toxicity, co‐morbidities, operative complications, or patient choice .…”

Postoperative survival following perioperative MAGIC versus neoadjuvant OE02-type chemotherapy in oesophageal adenocarcinoma

“…2,4 Conversely, an examination of 100 patients treated with MAGIC chemotherapy in Nottingham revealed that as many as 19% of those commencing MAGIC treatment with curative intent failed to proceed to surgery. 15 Although not demonstrated in the original trials, the longer and more aggressive chemotherapy given in a MAGIC regimen would intuitively be expected to result in greater toxicity and disease progression prior to surgery in resistant cases. As such, an intention-to-treat analysis (that included the survival outcomes of those who started treatment but did not undergo surgery) would be a more accurate comparison.…”