Phase III Trial to Compare Adjuvant Chemotherapy With Capecitabine and Cisplatin Versus Concurrent Chemoradiotherapy in Gastric Cancer: Final Report of the Adjuvant Chemoradiotherapy in Stomach Tumors Trial, Including Survival and Subset Analyses

Abstract

In D2-resected GC, both adjuvant chemotherapy and chemoradiotherapy are tolerated and equally beneficial in preventing relapse. Because results suggest a significant DFS effect of chemoradiotherapy in subsets of patients, the ARTIST 2 trial evaluating adjuvant chemotherapy and chemoradiotherapy in patients with node-positive, D2-resected GC is under way.

Report from the 17th Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Edmonton, Alberta; 11–12 September 2015

“…However, in an unplanned subgroup analysis, the patients with lymph node involvement and intestinal-type histology were observed to experience a statistically significant disease-free survival advantage. Furthermore, a more detailed analysis of first site of failure demonstrated a clinically relevant difference in patterns of relapse, with locoregional relapse occurring more frequently in the capecitabine-cisplatin arm than in the capecitabinecisplatin and radiation arm (13% vs. 7%, p = 0.0033), but no difference in the rate of distant metastasis 79 . The Cancer and Leukemia Group B 80101 trial attempted to improve the ctx regimen, comparing postoperative epirubicincisplatin-5fu before and after ccrt with 5fu before and after ccrt (per the INT0116 regimen); on interim reporting, the authors did not find a survival benefit 80 .…”

Neoadjuvant therapy for gastroesophageal adenocarcinoma

“…They were randomized in two therapeutic arms: Surgery alone vs surgery combined with adjuvant chemoradiotherapy. Recently, the ARTIST study reported a benefit of adjuvant chemoradiotherapy with capecitabine and cisplatin on diseasefree survival of patients with node positive and intestinaltype gastric adenocarcinoma compared with patients treated with adjuvant chemo therapy alone [19] . In all cases, the nutritional status of patients should systematically and safely be evaluated before initiating adjuvant therapy at 6 wk postsurgery [20] .…”

Chemoradiation for gastric cancer: controversies, updates and novel techniques

“…The study reported updated results with long-term follow up, and they were consistent with the 3-year outcome. 16,17 The negative results of the ARTIST trial challenged the effect of adjuvant CRT in patients undergoing D2 and R0 gastrectomy. However, subgroup analysis showed a significantly improved 3-year DFS in patients with positive lymph nodes (72% in the XP arm vs 76% in the XPRT arm; p 5 0.04).…”

“…However, subgroup analysis showed a significantly improved 3-year DFS in patients with positive lymph nodes (72% in the XP arm vs 76% in the XPRT arm; p 5 0.04). Based on these results, Korean scholars have initiated a new multicentre Phase III randomized trial named the ARTIST II trial, 17 in which 900 patients who underwent D2 dissection are allocated into three groups: one group receiving S-1 for 1 year; one group receiving S-1 and oxaliplatin (SOX) for 6 months; and the third group receiving two cycles of SOX followed by 45 Gy of radiation with concurrent S-1, followed by four cycles of SOX. In this trial, all patients are stage II-III with positive lymph nodes, and the stratification factors are stage, type of surgery and Lauren classification.…”