Perioperative chemotherapy for locally advanced gastric cancer in Japan: current and future perspectives

Abstract

The standard treatment for locally advanced gastric cancer differs across the world. In western countries, perioperative chemotherapy or postoperative adjuvant chemoradiotherapy are the preferred treatment options, whereas in Asia, D2 gastrectomy followed by postoperative adjuvant chemotherapy is standard. In Japan, adjuvant chemotherapy with S-1 is the standard treatment for pStage II gastric cancer, whereas adjuvant chemotherapy with a doublet regimen is preferred for pStage III gastric cancer. The efficacy of preoperative neoadjuvant chemotherapy using S-1 plus cisplatin, has been investigated in selected patients with expected poor survival outcomes. To expand the indications for neoadjuvant chemotherapy, a clinical trial investigating the efficacy of preoperative S-1 plus oxaliplatin in patients with cStage III (cT3-4N1-3) gastric cancer (JCOG1509) is ongoing in Japan. The addition of immune checkpoint inhibitors to cytotoxic chemotherapy also seems promising and is being investigated in international randomized clinical trials. Although we have to await the final results of these studies, preoperative neoadjuvant chemotherapy is a promising treatment strategy and likely to become standard treatment for locally advanced gastric cancer in Japan.

Inhibiting PP2Acα Promotes the Malignant Phenotype of Gastric Cancer Cells through the ATM/METTL3 Axis

“…The poor prognosis associated with advanced GC has become a major public health problem [24][25][26]. The radical resection of GC has been well-developed since the 1980s, chemotherapy regimens have improved in recent years [24,27,28], and advanced intervention methods, such as arterial interventional embolization for distant metastases and intraperitoneal hyperthermic perfusion therapy, have emerged. However, the prognoses of patients with advanced GC have not reached public expectations.…”

Changing trends of clinicopathologic features and survival duration after surgery for gastric cancer in Northeast China

“…This also shows that for these patients, we should seek more comprehensive treatment. Of course, in recent years, a large number of prospective randomized studies have confirmed that adjuvant chemotherapy and neoadjuvant chemotherapy have significantly improved the prognosis of advanced GC[ 49 , 50 ]. This is also strong evidence for the improvement in the survival of patients with GC in recent decades.…”

Surgical Management of Gastric Cancer: A Systematic Review

“…Despite advances in the field of oncology, where radiotherapy, neo and adjuvant chemotherapy may improve the outcome, the only treatment with curative intent is represented by surgery as part of a multimodal therapy [4]. Two concepts may be adopted in appropriate cases, neoadjuvant treatment before gastrectomy or primary surgical resection followed by chemotherapy [5].…”