General Session 2: Perioperative Therapies for Gastric Cancer
Trevor Leong, MBBS, MD, FRANZCR
Peter MacCallum Cancer Centre
Neoadjuvant Strategies and Indications
Conclusions:
Preoperative therapy better tolerated than postoperative therapy
Preoperative therapy allows tumor downstaging
Preoperative (perioperative) chemotherapy is a standard of care in Western countries
Preoperative chemoradiation for gastric cancer is safe, feasible and has an acceptable toxicity profile
Preoperative chemoradiation does not increase surgical morbidity
Gastric irradiation is complex and requires strict QA
Phase III Preoperative chemoradiation trials are ongoing
David Cunningham, MD
The Royal Marsden NHS Foundation Trust, Sutton and London Hospital
Optimizing Adjuvant Therapy
Summary:
Adjuvant chemotherapy improves survival in gastric cancer
Adjuvant CRT benefits patients with limited node dissection
Patients with MSI-H tumors have a better prognosis and do not appear to benefit from adjuvant chemotherapy
Gene expression and radiomic signatures provide valuable prognostic and predictive information
Shaila Merchant, MD, MSc, MHSc, FRCSC, FACS
Queen's University
Disparities in Management of Esophago-Gastric Cancers
Key Points:
Disparities in survival are large, multi-factorial and linked
Need to aim beyond describing disparities, try to narrow the gap
Need buy-in from clinicians, policymakers, government
Limitation of the literature
- retrospective
- individual factor contributions unclear
Marcia Cruz-Correa, MD, PhD
The University of Puerto Rico and MD Anderson Cancer Center
Current and Upcoming Clinical Trials
Reported two trials:
Study Title: Adjuvant Immunotherapy in Patients With Resected Gastric Cancer Following Preoperative Chemotherapy With High Risk for Recurrence (N+ and/or R1): an Open Label Randomized Controlled Phase-2-study
ClinicalTrials.gov Identifier: 03443856 Opening soon
Study Title: A Multicenter, Double-blind, Randomized Study in Patients With Gastric Cancer Undergoing Postoperative Adjuvant Chemotherapy
ClinicalTrials.gov Identifier: 03006705 currently accruing
Study Title: Prospective Multicenter Phase III Trial Using CRS With / Without HIPEC After Preoperative Chemotherapy in Patients With Peritoneal Carcinomatosis of Gastric Cancer Incl. Adenocarcinoma of the Esophagogastric Junction
ClinicalTrials.gov Identifier: 02158988 Recruiting
Study Title: Targeted Chemoprevention of Gastric Carcinogenesis in High Risk Populations
ClinicalTrials.gov Identifier: 02794428 Currently Recruiting