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Adjuvant and Neoadjuvant Therapy for Gastric Carcinoma

An Evidence-Based Review

  • Review Article
  • Published:
American Journal of Cancer

Abstract

Despite its declining incidence, gastric cancer remains one of the leading causes of cancer-related death worldwide. The definitive management of localized gastric cancer has been the center of much international controversy over the years; surgery remains the mainstay, with debate centering on the required extent of lymph node resection. The role of adjuvant chemotherapy has been studied for decades, but because trials have been underpowered, it has been difficult to demonstrate a statistically significant benefit. Recently, four large meta-analyses have been published on adjuvant chemotherapy in gastric cancer. The first three have been criticized for their methodology, but the most recent meta-analysis was well conducted and showed a statistically significant benefit in favor of adjuvant chemotherapy. The heterogeneity of chemotherapy schedules included in this meta-analysis, however, makes it difficult to define the current standard. Randomized trials in the metastatic setting have shown that the combinations of epirubicin, cisplatin, and infusional fluorouracil (ECF) and docetaxel, cisplatin, and fluorouracil (TCF) have demonstrated superiority over other regimens. The role of preoperative chemotherapy is currently under investigation, with results from the MAGIC (Medical Research Council Adjuvant Gastric Infusional Chemotherapy) trial demonstrating a significant improvement in resectability, progression-free survival, and overall survival with perioperative therapy in patients with operable gastric cancer. Postoperative chemoradiotherapy has also been adopted as a standard of care in the US following the publication of the results of the Intergroup Study, INT-0116, although there remains debate over the relative benefits of more radical surgery versus the use of radiation with adjuvant treatment. It is clear that adjuvant therapy is now an appropriate addition to surgery, although there are still further questions regarding the optimal protocols.

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No sources of funding were used to assist in the preparation of this review. The authors have no conflicts of interest that are directly relevant to the content of this review.

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  1. Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand

    Richard N. Sullivan

  2. Cancer Trials New Zealand, School of Medical Sciences, The University of Auckland, Auckland, New Zealand

    Michael P. N. Findlay

  3. Division of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag # 1, A’Beckett St, Melbourne, VIC, 8006, Australia

    John Zalcberg

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Sullivan, R.N., Findlay, M.P.N. & Zalcberg, J. Adjuvant and Neoadjuvant Therapy for Gastric Carcinoma. Am J Cancer 5, 111–121 (2006). https://doi.org/10.2165/00024669-200605020-00005

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