Recent advances in the management of gastric adenocarcinoma patients

Harada, Kazuto; Lopez, Anthony; Shanbhag, Namita; Badgwell, Brian D.; Baba, Hideo; Ajani, Jaffer A.

doi:10.12688/f1000research.15133.1

Cited by 27 publications

(24 citation statements)

References 95 publications

(111 reference statements)

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“…OS is a major oncologic outcome. In this study, the five-year OS was similar to that previously reported [36]. Furthermore, the results also indicate the oncological safety of RG as well as that of LG.…”

Section: Discussionsupporting

confidence: 90%

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

et al. 2019

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Background Data regarding the long-term oncological outcomes of robotic gastrectomy (RG) are limited despite the increased commonality of this method as an alternative for gastric cancer treatment. Here, we conducted a meta-analysis to evaluate the long-term oncological outcomes of RG in comparison to that of laparoscopic gastrectomy (LG). Methods The PubMed, ISI Web of Science, EMBASE, and Cochrane Library databases were comprehensively searched for studies that compared RG and LG in terms of their long-term survival outcomes. The hazard ratios (HRs) of overall survival (OS), disease-free survival (DFS), and relapse-free survival (RFS) were obtained, while the odds ratio (OR) was recorded for the recurrence rate. A sensitivity analysis was performed. Egger’s test and Begg’s test were applied to evaluate publication bias. Results Eight studies were identified and involved 3410 gastric cancer patients (RG, 1009; LG, 2401). The two groups had no significant differences in OS (HR, 0.98; 95% CI, 0.80–1.20; P = 0.81), DFS (HR, 1.36; 95% CI, 0.33–5.59; P = 0.67), RFS (HR, 0.92; 95% CI, 0.72–1.19; P = 0.53), or recurrence rate (OR, 0.92; 95% CI, 0.71–1.19; P = 0.53). Moreover, the two techniques were comparable in length of hospital stay (LOS), postoperative complication rate, 30-day mortality rate, and rate of conversion to open surgery. Conclusions The long-term oncological outcomes, expressed as OS, DFS, RFS, and recurrence rate, were similar between RG and LG. However, more randomized controlled trials with rigorous study designs and patient cohorts are needed to evaluate the oncologic outcomes of RG in patients with gastric cancer. Electronic supplementary material The online version of this article (10.1186/s12957-019-1628-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 90%

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

et al. 2019

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“…The timing to perform chemotherapy is different in the world. In the European Union and the USA, preoperative chemotherapy is advocated while postoperative adjuvant chemotherapy is encouraged in Asia [6].…”

Section: Introductionmentioning

confidence: 99%

Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

Wang

Yang

et al. 2020

BMC Cancer

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Background: Surgery is the only way to cure gastric adenocarcinoma (GAC), and chemotherapy is the basic adjuvant management for GAC. A significant prognostic nomogram for predicting the respective disease-specific survival (DSS) rates of GAC patients who receive surgery and chemotherapy has not been established. Objective: We were planning to establish a survival nomogram model for GAC patients who receive surgery and chemotherapy. Methods: We identified 5764 GAC patients who had received surgery and chemotherapy from the record of Surveillance, Epidemiology, and End Results (SEER) database. About 70% (n = 4034) of the chosen GAC patients were randomly assigned to the training set, and the rest of the included ones (n = 1729) were assigned to the external validation set. A prognostic nomogram was constructed by the training set and the predictive accuracy of it was validated by the validation set. Results: Based on the outcome of a multivariate analysis of candidate factors, a nomogram was developed that encompassed age at diagnosis, number of regional lymph nodes examined after surgery, number of positive regional lymph nodes, sex, race, grade, derived AJCC stage, summary stage, and radiotherapy status. The C-index (Harrell's concordance index) of the nomogram model was some larger than that of the traditional seventh AJCC staging system (0.707 vs 0.661). Calibration plots of the constructed nomogram displayed that the probability of DSS commendably accord with the survival rate. Integrated discrimination improvement (IDI) revealed obvious increase and categorical net reclassification improvement (NRI) showed visible enhancement. IDI for 3-, 5-and 10year DSS were 0.058, 0.059 and 0.058, respectively (P > 0.05), and NRI for 3-, 5-and 10-year DSS were 0.380 (95% CI = 0.316-0.470), 0.407 (95% CI = 0.350-0.505), and 0.413 (95% CI = 0.336-0.519), respectively. Decision curve analysis (DCA) proved that the constructed nomogram was preferable to the AJCC staging system. Conclusion: The constructed nomogram supplies more credible DSS predictions for GAC patients who receive surgery and chemotherapy in the general population. According to validation, the new nomogram will be beneficial in facilitating individualized survival predictions and useful when performing clinical decision-making for GAC patients who receive surgery and chemotherapy.

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“…Compared to best supportive care, irinotecan alone in the second-line setting showed a median PFS of 2.6 months (95% CI:1.7-4.3 months) [12]. While anti-PD-1 therapy dependent on tumor location and histology along with PD-L1 expression and CPS score showed responses of approximately 11-22% [1,2,13,14]. In the second-line setting compared to paclitaxel, pembrolizumab had a reported median PFS of 1.5 months (95% CI: 1.4-2 months) [13].…”

Section: Discussion/conclusionmentioning

confidence: 99%

Nivolumab in Combination with Irinotecan and 5-Fluorouracil (FOLFIRI) for Refractory Advanced Gastroesophageal Cancer

et al. 2020

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Introduction: Advanced unresectable gastroesophageal cancers continue to confer a dismal patient prognosis. Limited options remain once the cancer is refractory to cytotoxics/biologics (like irinotecan, taxane, and ramucirumab). Recently, anti-programmed death-1 (anti-PD-1) inhibitors have been used with limited efficacy in select patients with adenocarcinoma. Similarly, irinotecan-based therapy has marginal efficacy. We combined irinotecan plus a fluoropyrimidine with an anti-PD-1 antibody, nivolumab, with hopes of having a higher advantage for patients. Objectives: Primary objective was to assess safety judged by toxicities, dose delays, or dose reductions. Secondary endpoints included the assessment of response, overall survival (OS), and progression-free survival (PFS). Methods: We treated 15 patients with this combination during July 2017 to April 2019. Patients were included if they had follow-up at our institution. Results: Median doses given were nivolumab 240 mg + iri-notecan 120 mg/m 2 + 5-FU 2,000 mg/m 2 over 46-48 h (or capecitabine 1,250 mg/m 2 /day; 7 days on, 7 days off) given every 2 weeks. Median age of the patients was 55 years, and all patients had an ECOG performance status of 0-1. The patients had a median of 1 prior therapy. Slightly over half of the patients had PD-L1 expression. The median number of cycles was 7. Five patients (33%) had a dose delay or dose adjustment. The most common reason for dose delay or adjustment was grade 2 fatigue. Disease control (response or stability) on first scan was 73.3% (n = 11). Median PFS and OS for the entire group was 7 and 13.3 months, respectively. Conclusion: In this small cohort of patients, we conclude that this combination is quite feasible and resulted in prolonged stability in some patients. Further development of this regimen is warranted.

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Recent advances in the management of gastric adenocarcinoma patients

Cited by 27 publications

References 95 publications

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

Comparative analysis of robotic gastrectomy and laparoscopic gastrectomy for gastric cancer in terms of their long-term oncological outcomes: a meta-analysis of 3410 gastric cancer patients

Nomogram for predicting the survival of gastric adenocarcinoma patients who receive surgery and chemotherapy

Nivolumab in Combination with Irinotecan and 5-Fluorouracil (FOLFIRI) for Refractory Advanced Gastroesophageal Cancer

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